Provider Demographics
NPI:1114183860
Name:MIDLANDS SPECIFIC CHIROPRACTIC
Entity Type:Organization
Organization Name:MIDLANDS SPECIFIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEMETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-571-1265
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-1118
Mailing Address - Country:US
Mailing Address - Phone:803-408-2303
Mailing Address - Fax:
Practice Address - Street 1:1100 ROSE STREET
Practice Address - Street 2:SUITE A&B
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045
Practice Address - Country:US
Practice Address - Phone:803-408-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty