Provider Demographics
NPI:1073293304
Name:100 CHIRO SPIVEY LLC
Entity Type:Organization
Organization Name:100 CHIRO SPIVEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-641-1157
Mailing Address - Street 1:2118 HIGHWAY 41 STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6206
Mailing Address - Country:US
Mailing Address - Phone:910-641-1157
Mailing Address - Fax:
Practice Address - Street 1:2118 HIGHWAY 41 STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-6206
Practice Address - Country:US
Practice Address - Phone:910-641-1157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty