Provider Demographics
NPI:1174943864
Name:ALAN DINEHART, DC, A PROFESSIONAL CORP
Entity type:Organization
Organization Name:ALAN DINEHART, DC, A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-830-4689
Mailing Address - Street 1:30 ROBERT SMALLS PKWY # 1
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-4201
Mailing Address - Country:US
Mailing Address - Phone:813-525-1166
Mailing Address - Fax:
Practice Address - Street 1:30 ROBERT SMALLS PKWY # 1
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4201
Practice Address - Country:US
Practice Address - Phone:813-525-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty