1336110618 NPI number — THE CHIROPRACTIC CENTER OF MAULDIN INC.

Table of content: (NPI 1336110618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336110618 NPI number — THE CHIROPRACTIC CENTER OF MAULDIN INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHIROPRACTIC CENTER OF MAULDIN INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336110618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 982
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAULDIN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29662-0982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-297-6270
Provider Business Mailing Address Fax Number:
864-288-9010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14C E BUTLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAULDIN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29662-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-297-6270
Provider Business Practice Location Address Fax Number:
864-288-9010
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
864-297-6270

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0883 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CHO883 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GCH302 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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