Provider Demographics
NPI:1346843489
Name:ENHANCED LIVING-SIMPSONVILLE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ENHANCED LIVING-SIMPSONVILLE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-380-8804
Mailing Address - Street 1:140 SAGE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-0957
Mailing Address - Country:US
Mailing Address - Phone:864-848-0640
Mailing Address - Fax:864-848-0646
Practice Address - Street 1:227 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2310
Practice Address - Country:US
Practice Address - Phone:864-848-0640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty