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General NPI Number Information
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NPI Number | 1992965503
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Entity Type | Organization
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Legal Business Name | COLLETON CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 211 EDDIE CHASTEEN DRIVE
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City | WALTERBORO
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State | SC
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Zip | 29488
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Country | US
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Telephone | 843-539-1111
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Fax | 843-782-4104
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Provider Business Mailing Address
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Address Line | 211 EDDIE CHASTEEN DRIVE
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City | WALTERBORO
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State | SC
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Zip | 29488
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Country | US
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Telephone | 843-539-1111
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. BRIANNE KRISTA GALLAGHER
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Credential | DC
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Telephone | 843-539-1111
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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 | 3350
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License Number State | SC
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