Provider Demographics
NPI:1588073233
Name:SOUTHEASTERN CHIROPRACTIC CENTER P C
Entity type:Organization
Organization Name:SOUTHEASTERN CHIROPRACTIC CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:803-553-3368
Mailing Address - Street 1:PO BOX 11596
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29211-1596
Mailing Address - Country:US
Mailing Address - Phone:803-553-3368
Mailing Address - Fax:
Practice Address - Street 1:6420 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1632
Practice Address - Country:US
Practice Address - Phone:803-553-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1581111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1578629861OtherNPI INDIVIDUAL
SC1578629861OtherNPI INDIVIDUAL