Provider Demographics
NPI:1669646105
Name:PALMETTO WELLNESS AND INJURY CENTER OF HARTSVILLE SC PA
Entity type:Organization
Organization Name:PALMETTO WELLNESS AND INJURY CENTER OF HARTSVILLE SC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:843-332-6191
Mailing Address - Street 1:331 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5734
Mailing Address - Country:US
Mailing Address - Phone:843-332-6191
Mailing Address - Fax:843-332-4408
Practice Address - Street 1:331 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5734
Practice Address - Country:US
Practice Address - Phone:843-332-6191
Practice Address - Fax:843-332-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH605Medicaid
SCCH2622Medicaid