Provider Demographics
NPI:1215665252
Name:HEALTHY ROOTS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:HEALTHY ROOTS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-475-7470
Mailing Address - Street 1:3195 LEAPHART RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3001
Mailing Address - Country:US
Mailing Address - Phone:803-834-3000
Mailing Address - Fax:
Practice Address - Street 1:3195 LEAPHART RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3001
Practice Address - Country:US
Practice Address - Phone:803-834-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty