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General NPI Number Information
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NPI Number | 1871349522
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 999 LAKE HUNTER CIR STE C
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-5427
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Country | US
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Telephone | 854-354-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 1589 BOURNE XING
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-7560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/FOUNDER
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Name | DR. DEVIN DICENZO
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Credential | DC
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Telephone | 703-906-8552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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