Provider Demographics
NPI:1427116482
Name:PAGELAND CHIROPRACTIC OFFICE, PA
Entity type:Organization
Organization Name:PAGELAND CHIROPRACTIC OFFICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PICOLET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-672-2045
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-0508
Mailing Address - Country:US
Mailing Address - Phone:843-672-2045
Mailing Address - Fax:843-672-2048
Practice Address - Street 1:213 N PEARL ST
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-1942
Practice Address - Country:US
Practice Address - Phone:843-672-2045
Practice Address - Fax:843-672-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH260Medicaid