NPIMap

Organization Active NPI

Columbia Family Chiropractic Northeast LLC

  • Chiropractor
  • Columbia, SC
National Provider Identifier
1407569049
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
COLUMBIA FAMILY CHIROPRACTIC NORTHEAST LLC
Practice address
124 N Brickyard Rd
Columbia, SC 29223-6902
Phone
(800) 788-8831
NPI assigned
Dec 28, 2022
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas StetsonNPI 1669786729
Title
Owner
Phone
(803) 995-9193

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary
Independent Medical Examiner ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NI0013X

Addresses

Primary practice location

124 N Brickyard Rd
Columbia, SC 29223-6902

Mailing address

124 N Brickyard Rd
Columbia, SC 29223-6902
Phone (803) 788-8831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230425002157 SC Part B Supplier - Clinic/Group Practice 5496110538 Receives reassigned benefits from 11 practitioners
Practice locations: Columbia, SC

National Provider Directory

National Provider Directory

Locations

124 N Brickyard Rd
Columbia, SC 29223
Phone (803) 788-8831

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1407569049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 N BRICKYARD RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236902",
            "telephone_number": "803-788-8831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 N BRICKYARD RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236902",
            "telephone_number": "800-788-8831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA FAMILY CHIROPRACTIC NORTHEAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-28",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "STETSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-995-9193"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111NI0013X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Independent Medical Examiner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.