Provider Demographics
NPI:1235501990
Name:DYNAMIC CHIROPRACTIC & SPINAL REHAB
Entity Type:Organization
Organization Name:DYNAMIC CHIROPRACTIC & SPINAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVSOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-548-6200
Mailing Address - Street 1:4252 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7990
Mailing Address - Country:US
Mailing Address - Phone:618-292-4832
Mailing Address - Fax:803-548-6222
Practice Address - Street 1:4252 WALKER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-7990
Practice Address - Country:US
Practice Address - Phone:618-292-4832
Practice Address - Fax:803-548-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty