Provider Demographics
NPI:1366567497
Name:OFF-ISLAND CHIROPRACTIC, PC
Entity type:Organization
Organization Name:OFF-ISLAND CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-815-3400
Mailing Address - Street 1:1 SHERINGTON DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6018
Mailing Address - Country:US
Mailing Address - Phone:843-815-3400
Mailing Address - Fax:843-815-3402
Practice Address - Street 1:1 SHERINGTON DR
Practice Address - Street 2:SUITE E
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6018
Practice Address - Country:US
Practice Address - Phone:843-815-3400
Practice Address - Fax:843-815-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8781OtherMEDICARE PTAN
SCU18083Medicare UPIN