Provider Demographics
NPI:1033508940
Name:HAZLEWOOD CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:HAZLEWOOD CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HAZLEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-818-5522
Mailing Address - Street 1:622 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1605
Mailing Address - Country:US
Mailing Address - Phone:803-818-5522
Mailing Address - Fax:803-818-5523
Practice Address - Street 1:622 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1605
Practice Address - Country:US
Practice Address - Phone:803-818-5522
Practice Address - Fax:803-818-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U902840281Medicare UPIN