Provider Demographics
NPI:1548344740
Name:PALMETTO CHIROPRACTIC, IRMO
Entity type:Organization
Organization Name:PALMETTO CHIROPRACTIC, IRMO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:HELDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-749-8522
Mailing Address - Street 1:800 COLUMBIANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-749-8522
Mailing Address - Fax:
Practice Address - Street 1:800 COLUMBIANA DR
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8527
Practice Address - Country:US
Practice Address - Phone:803-749-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1255309068OtherPERSONAL NPI NUMBER