Basic Information
| Provider Information | |||||||||
| NPI: | 1538417001 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOW COUNTRY PHYSICAL MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4531 HARD SCRABBLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292298561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034198700 | ||||||||
| FaxNumber: | 8038656760 | ||||||||
| Practice Location | |||||||||
| Address1: | 4531 HARD SCRABBLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292298561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034198700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | BARTON | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | BEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8034198700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2581 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.