Provider Demographics
NPI:1104223130
Name:PALMETTO SPORTS AND FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:PALMETTO SPORTS AND FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:864-244-4123
Mailing Address - Street 1:4200 E NORTH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2437
Mailing Address - Country:US
Mailing Address - Phone:864-244-4123
Mailing Address - Fax:864-244-6879
Practice Address - Street 1:4200 E NORTH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2437
Practice Address - Country:US
Practice Address - Phone:864-244-4123
Practice Address - Fax:864-244-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty