Basic Information
| Provider Information | |||||||||
| NPI: | 1861708117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRITY CHIROPRACTIC CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110A SPRINGHALL DR | ||||||||
| Address2: | |||||||||
| City: | GOOSE CREEK | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294455335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432701288 | ||||||||
| FaxNumber: | 8435534436 | ||||||||
| Practice Location | |||||||||
| Address1: | 110A SPRINGHALL DR | ||||||||
| Address2: | |||||||||
| City: | GOOSE CREEK | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294455335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432701288 | ||||||||
| FaxNumber: | 8435534436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2010 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | MURRAY | ||||||||
| AuthorizedOfficialFirstName: | HUBERT | ||||||||
| AuthorizedOfficialMiddleName: | AUSTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8432701288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 1425 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1425 | 05 | SC | MEDICAID |