Provider Demographics
NPI:1245527092
Name:CHIROPRACTIC ENTERPRISES, LLC
Entity type:Organization
Organization Name:CHIROPRACTIC ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEAVNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-665-5505
Mailing Address - Street 1:2234 W PALMETTO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4047
Mailing Address - Country:US
Mailing Address - Phone:843-665-5505
Mailing Address - Fax:843-665-7447
Practice Address - Street 1:2234 W PALMETTO ST
Practice Address - Street 2:SUITE A
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4047
Practice Address - Country:US
Practice Address - Phone:843-665-5505
Practice Address - Fax:843-665-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2207111N00000X
SC2354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty