Organization
ADVANCED CHIROPRACTIC CENTER
Active
Other names
Advanced Chiropractic Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH W JORDAN DC (OWNER)
(843) 545-1396
Entity
Organization
Contact information
Practice address
705 NORTH FRASER STREET, ADVANCED CHIROPRACTIC CENTER, GEORGETOWN, SC 29440
(843) 545-1396
(843) 527-8353
Mailing address
POST OFFICE BOX 958, ADVANCED CHIROPRACTIC CENTER, GEORGETOWN, SC 29440
(843) 545-1396
(843) 527-8353
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3056
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CH3056
—
SC
01
—
GCH507
MEDICAID GRP #
SC
Enumeration date
02/13/2008
Last updated
07/16/2008
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