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General NPI Number Information
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NPI Number | 1659763704
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Entity Type | Organization
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Legal Business Name | CHARLESTON BRACING, LLC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 9313 MEDICAL PLAZA DR STE 303
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9197
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Country | US
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Telephone | 843-410-9815
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Fax |
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Provider Business Mailing Address
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Address Line | 9313 MEDICAL PLAZA DR STE 303
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9197
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Country | US
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Telephone | 843-410-9815
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | JASON HIGHSMITH
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Credential | M.D.
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Telephone | 843-410-9815
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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 |
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License Number State |
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