Provider Demographics
NPI:1255659710
Name:EMORY UPPER CERVICAL CHIROPRACTIC DBA WELLNESS CHIROPRACTIC HEALTH CEN
Entity Type:Organization
Organization Name:EMORY UPPER CERVICAL CHIROPRACTIC DBA WELLNESS CHIROPRACTIC HEALTH CEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:EMORY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-486-9600
Mailing Address - Street 1:1660A E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9706
Mailing Address - Country:US
Mailing Address - Phone:864-486-9600
Mailing Address - Fax:
Practice Address - Street 1:1660A E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9706
Practice Address - Country:US
Practice Address - Phone:864-486-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-08
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9520OtherMEDICARE PTAN GROUP NUMBER