Provider Demographics
NPI:1104152990
Name:PALMETTO STATE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:PALMETTO STATE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:CHADWICK
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-898-1318
Mailing Address - Street 1:3427 HIGHWAY 153
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7725
Mailing Address - Country:US
Mailing Address - Phone:864-220-5424
Mailing Address - Fax:864-220-5423
Practice Address - Street 1:3427 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7725
Practice Address - Country:US
Practice Address - Phone:864-220-5424
Practice Address - Fax:864-220-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty