Provider Demographics
NPI:1265322499
Name:CARRAWAY, BRENT ALLEN (DC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALLEN
Last Name:CARRAWAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 BULTMAN DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2516
Mailing Address - Country:US
Mailing Address - Phone:803-773-3421
Mailing Address - Fax:
Practice Address - Street 1:711 BULTMAN DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2516
Practice Address - Country:US
Practice Address - Phone:803-773-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor