The Sublime Spine, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3605 Issued in SC

Legal business name

THE SUBLIME SPINE, LLC

Practice address

1175 Folly Rd
Suite E
Charleston, SC 29412-4130

Phone

(843) 225-1236

Fax

(843) 225-1237

NPI assigned

Nov 8, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Lee David Russo, DCNPI 1841407616

Title

Owner

Phone

(843) 225-1236

Specialties & licenses 1

Addresses

Other names 1

• Health Source of James Island Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lee David Russo, D.C.

  • Chiropractor
  • Charleston, SC
  • NPI 1841407616
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1871894816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 FOLLY RD",
            "address_2": "SUITE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294124130",
            "telephone_number": "843-225-1236",
            "fax_number": "843-225-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 FOLLY RD",
            "address_2": "SUITE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294124130",
            "telephone_number": "843-225-1236",
            "fax_number": "843-225-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SUBLIME SPINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-225-1236",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Source of James Island",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Medical University of South Carolina Foundation
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• The Pharmacy Club, LLC
• The Retina Center of Charleston, PA
• Samantha Jean Theobald, FNP
• Calene Sherrie Theodore
• Therapeutic Intervention Services, Inc.
• Therapy Centers of South Carolina, P.a.
• Therapy Continuum, LLC

• Chiropractor in Charleston, SC
• Providers in Charleston, SC by specialty
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.