Provider Demographics
NPI:1104240803
Name:CHIROWELLNESS, INC.
Entity type:Organization
Organization Name:CHIROWELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-681-7777
Mailing Address - Street 1:1403 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1654
Mailing Address - Country:US
Mailing Address - Phone:843-681-7777
Mailing Address - Fax:843-681-7775
Practice Address - Street 1:1403 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1654
Practice Address - Country:US
Practice Address - Phone:843-681-7777
Practice Address - Fax:843-681-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center