Provider Demographics
NPI:1861693905
Name:CAROLINA CHIROPRACTIC
Entity type:Organization
Organization Name:CAROLINA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MATHEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-723-6475
Mailing Address - Street 1:PO BOX 21969
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29413-1969
Mailing Address - Country:US
Mailing Address - Phone:843-723-6344
Mailing Address - Fax:843-723-6397
Practice Address - Street 1:119 SPRING ST
Practice Address - Street 2:STE 4
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5259
Practice Address - Country:US
Practice Address - Phone:843-723-6475
Practice Address - Fax:843-723-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4634Medicare UPIN