Provider Demographics
NPI:1366401697
Name:FIRST CHOICE CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:FIRST CHOICE CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YERGEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-878-0615
Mailing Address - Street 1:2525 GENTRY MEMORIAL HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-9426
Mailing Address - Country:US
Mailing Address - Phone:864-878-0615
Mailing Address - Fax:864-878-0667
Practice Address - Street 1:2525 GENTRY MEMORIAL HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-9426
Practice Address - Country:US
Practice Address - Phone:864-878-0615
Practice Address - Fax:864-878-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1613Medicaid
SCGCH443Medicaid