Provider Demographics
NPI:1346789419
Name:KORIKOV, VENIAMIN (DC)
Entity Type:Individual
Prefix:
First Name:VENIAMIN
Middle Name:
Last Name:KORIKOV
Suffix:
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-0041
Mailing Address - Country:US
Mailing Address - Phone:864-574-6840
Mailing Address - Fax:864-587-8227
Practice Address - Street 1:1230 JOHN B WHITE SR BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3929
Practice Address - Country:US
Practice Address - Phone:864-574-6840
Practice Address - Fax:864-587-8227
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor