Provider Demographics
NPI:1598035958
Name:CAROLINA WELLNESS AND HEALTH, LLC
Entity type:Organization
Organization Name:CAROLINA WELLNESS AND HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-226-0217
Mailing Address - Street 1:1310 PINE LOG RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7890
Mailing Address - Country:US
Mailing Address - Phone:803-226-0217
Mailing Address - Fax:803-226-0459
Practice Address - Street 1:1310 PINE LOG RD
Practice Address - Street 2:SUITE B
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7890
Practice Address - Country:US
Practice Address - Phone:803-226-0217
Practice Address - Fax:803-226-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty