Provider Demographics
NPI:1144286568
Name:DR. BLACK'S FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:DR. BLACK'S FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-328-3444
Mailing Address - Street 1:430 S HERLONG AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1094
Mailing Address - Country:US
Mailing Address - Phone:803-328-3444
Mailing Address - Fax:803-328-6811
Practice Address - Street 1:430 S HERLONG AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1094
Practice Address - Country:US
Practice Address - Phone:803-328-3444
Practice Address - Fax:803-328-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2607Medicaid
SCCH2607Medicaid
SCU865730282Medicare ID - Type UnspecifiedMEDICARE #