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General NPI Number Information
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NPI Number | 1659591550
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Entity Type | Organization
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Legal Business Name | CHARLESTON BRACE COMPANY, LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 2270 ASHLEY CROSSING DR STE 140
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City | CHARLESTON
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State | SC
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Zip | 29414-5749
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Country | US
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Telephone | 843-871-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 2270 ASHLEY CROSSING DR SUITE 140
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City | CHARLESTON
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State | SC
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Zip | 29414-5732
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Country | US
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Telephone | 843-571-4646
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Fax | 843-571-1611
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Authorized Official
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Title or Position | OWNER
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Name | MR. NATHANIEL JACKSON
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Credential | CO, CPED
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Telephone | 843-571-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 010756087
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License Number State | SC
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