Provider Demographics
NPI:1679716971
Name:LLOP, RAFAEL (DC)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:LLOP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 SAVANNAH HWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7210
Mailing Address - Country:US
Mailing Address - Phone:843-640-1818
Mailing Address - Fax:843-352-4440
Practice Address - Street 1:568 SAVANNAH HWY UNIT C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7210
Practice Address - Country:US
Practice Address - Phone:843-640-1818
Practice Address - Fax:843-352-4440
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3432111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3432Medicaid
SCAA44210281Medicare PIN