Provider Demographics
NPI:1932207305
Name:CAROLINA FOREST CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:CAROLINA FOREST CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PELLICANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-236-2200
Mailing Address - Street 1:4016 RIVER OAKS DR # 149
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6673
Mailing Address - Country:US
Mailing Address - Phone:843-236-2200
Mailing Address - Fax:
Practice Address - Street 1:568 GEORGE BISHOP PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7339
Practice Address - Country:US
Practice Address - Phone:843-236-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36167OtherBC/BS OF MA
MA351103OtherHARVARD PILGRIM HEALTH
MAP-12032859OtherMULTIPLAN
MAY39207OtherBLUE CROSS BLUE SHIELD MA
MA0222552-01OtherBMC HEALTHNET
MAB207689-01OtherCIGNA
MA001610OtherTUFTS HEALTH PLAN
MA42309OtherFALLON COMMUNITY HEALTH P
MA44-00274OtherUNITED HEALTH CARE
MA995969OtherNETWORK HEALTH
MA1003195OtherAMERICAN SPECIALTY HEALTH
MA04-3403673-00OtherNEIGHBORHOOD HEALTH PLAN
MA646792OtherACN GROUP
SCCH3616Medicaid
MA04-3403673OtherPRIVATE HEALTHCARE SYSTEM
MA2114793OtherAETNA
MA1496056OtherFIRST HEALTH
SCA102Medicare UPIN