Provider Demographics
NPI:1053557843
Name:SPINE DOCTORS OF AIKEN LLC
Entity type:Organization
Organization Name:SPINE DOCTORS OF AIKEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:SHEKEIL
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-226-0061
Mailing Address - Street 1:2645 WHISKEY RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8075
Mailing Address - Country:US
Mailing Address - Phone:803-226-0061
Mailing Address - Fax:803-226-0077
Practice Address - Street 1:2645 WHISKEY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8075
Practice Address - Country:US
Practice Address - Phone:803-226-0061
Practice Address - Fax:803-226-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-28
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty