Provider Demographics
NPI:1316157480
Name:CHALFANT, THAD HERSCHEL (DC)
Entity type:Individual
Prefix:
First Name:THAD
Middle Name:HERSCHEL
Last Name:CHALFANT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:THAD
Other - Middle Name:H
Other - Last Name:CHALFANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:616 BULTMAN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2515
Mailing Address - Country:US
Mailing Address - Phone:803-775-8253
Mailing Address - Fax:803-775-8253
Practice Address - Street 1:616 BULTMAN DR
Practice Address - Street 2:SUITE B
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2515
Practice Address - Country:US
Practice Address - Phone:803-775-8253
Practice Address - Fax:803-775-8253
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH-190Medicaid