Provider Demographics
NPI:1275602260
Name:WOODLAND CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:WOODLAND CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-576-7070
Mailing Address - Street 1:PO BOX 2392
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2392
Mailing Address - Country:US
Mailing Address - Phone:864-576-7070
Mailing Address - Fax:864-576-9702
Practice Address - Street 1:1218 JOHN B WHITE SR BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3920
Practice Address - Country:US
Practice Address - Phone:864-576-7070
Practice Address - Fax:864-576-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH280Medicaid
SC8896Medicare PIN
SCGCH280Medicaid