Provider Demographics
NPI:1730864489
Name:CORRECTIVE CHIROPRACTIC FORT MILL
Entity type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC FORT MILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:839-600-3004
Mailing Address - Street 1:1826 HIGHWAY 160 W STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8254
Mailing Address - Country:US
Mailing Address - Phone:839-600-3004
Mailing Address - Fax:839-600-3004
Practice Address - Street 1:1826 HIGHWAY 160 W STE 103
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8254
Practice Address - Country:US
Practice Address - Phone:839-600-3004
Practice Address - Fax:839-600-3004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COHEN CHIROPRACTIC CENTRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty