Provider Demographics
NPI:1063462802
Name:ODYSSEY CHIROPRACTIC & MASSAGE THERAPY, LLC
Entity Type:Organization
Organization Name:ODYSSEY CHIROPRACTIC & MASSAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYNIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-246-0803
Mailing Address - Street 1:413 FARRS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-1858
Mailing Address - Country:US
Mailing Address - Phone:864-246-0803
Mailing Address - Fax:864-246-0555
Practice Address - Street 1:413 FARRS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-1858
Practice Address - Country:US
Practice Address - Phone:864-246-0803
Practice Address - Fax:864-246-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty