Provider Demographics
NPI:1003225871
Name:NEWBERRY FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:NEWBERRY FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENEIR
Authorized Official - Middle Name:ALEXANDRIA
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-524-1311
Mailing Address - Street 1:2541 EVANS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2963
Mailing Address - Country:US
Mailing Address - Phone:803-524-1311
Mailing Address - Fax:
Practice Address - Street 1:2541 EVANS ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2963
Practice Address - Country:US
Practice Address - Phone:803-524-1311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty