Provider Demographics
NPI:1073563003
Name:KLUCHARICH, DONNA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:KLUCHARICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S CASHUA DR # A-1
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5408
Mailing Address - Country:US
Mailing Address - Phone:843-664-0900
Mailing Address - Fax:843-664-0901
Practice Address - Street 1:423 S CASHUA DR # A-1
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5408
Practice Address - Country:US
Practice Address - Phone:843-664-0900
Practice Address - Fax:843-664-0901
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1405Medicaid
SCU09638Medicare UPIN