1104986124 NPI number — TURNER CHIROPRACTIC & REHAB LLC

Table of content: (NPI 1104986124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104986124 NPI number — TURNER CHIROPRACTIC & REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TURNER CHIROPRACTIC & REHAB LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104986124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 SINGLETON RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29526-9134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-347-9103
Provider Business Mailing Address Fax Number:
843-347-9104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 SINGLETON RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29526-9134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-347-9103
Provider Business Practice Location Address Fax Number:
843-347-9104
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
BRUNSON
Authorized Official Title or Position:
MEMBER/ CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
843-347-9103

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2768 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH2768 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com