Provider Demographics
NPI:1437367372
Name:DELSON PC
Entity type:Organization
Organization Name:DELSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVALINE
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:DELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCEP
Authorized Official - Phone:843-556-0101
Mailing Address - Street 1:1322 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5304
Mailing Address - Country:US
Mailing Address - Phone:843-556-0101
Mailing Address - Fax:843-556-8186
Practice Address - Street 1:1322 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5304
Practice Address - Country:US
Practice Address - Phone:843-556-0101
Practice Address - Fax:843-556-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2341Medicaid
SCCH2341Medicaid