| |
800 Columbiana Dr Ste 100, Gold's Gym Complex - Irmo, Irmo, SC 29063-7782 | |
(803) 271-4318 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | General Practice |
Location | 800 Columbiana Dr Ste 100, Irmo, South Carolina |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1174882112 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 25569823-0 (South Carolina) | Secondary |
208D00000X | General Practice | 25569823-0 (South Carolina) | Primary |
Mailing Address | Practice Location Address |
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800 Columbiana Dr Ste 100, Gold's Gym Complex - Irmo, Irmo, SC 29063-7782 Ph: (803) 271-4318 | 800 Columbiana Dr Ste 100, Gold's Gym Complex - Irmo, Irmo, SC 29063-7782 Ph: (803) 271-4318 |