Provider Demographics
NPI:1114357894
Name:HARPHAM, THEODORE LEON III (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:LEON
Last Name:HARPHAM
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MALLETT WAY
Mailing Address - Street 2:STE 102
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6066
Mailing Address - Country:US
Mailing Address - Phone:859-912-5509
Mailing Address - Fax:843-706-2178
Practice Address - Street 1:8451 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7587
Practice Address - Country:US
Practice Address - Phone:803-548-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10200111N00000X
SC3873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor