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NPI 1942481569

NPI 1942481569 : PICKENS FAMILY CHIROPRACTIC, LLC : PICKENS, SC

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General NPI Number Information
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    NPI Number           |    1942481569
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    Entity Type          |    Organization 
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    Legal Business Name  |    PICKENS FAMILY CHIROPRACTIC, LLC 
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Dates
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    Enumeration Date     |    11/26/2007
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    Last Update Date     |    11/26/2007
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Provider Practice Location Address
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    Address Line         |    207 W MAIN ST 
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    City                 |    PICKENS
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    State                |    SC
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    Zip                  |    29671-2222
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    Country              |    US
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    Telephone            |    864-898-3300
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    207 W MAIN ST 
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    City                 |    PICKENS
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    State                |    SC
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    Zip                  |    29671-2222
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    Country              |    US
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    Telephone            |    864-898-3300
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |    DR. BRIAN ROBERT DOOLEY 
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    Credential           |    DC
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    Telephone            |    864-898-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    111N00000X
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    Taxonomy Name        |    Chiropractor
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    License Number       |    3040
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    License Number State |    SC
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