Provider Demographics
NPI:1386190882
Name:39 STRIPES
Entity Type:Organization
Organization Name:39 STRIPES
Other - Org Name:REGENT PARK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-517-9713
Mailing Address - Street 1:8180 REGENT PKWY
Mailing Address - Street 2:104
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8417
Mailing Address - Country:US
Mailing Address - Phone:803-517-9713
Mailing Address - Fax:
Practice Address - Street 1:8180 REGENT PKWY
Practice Address - Street 2:104
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8417
Practice Address - Country:US
Practice Address - Phone:803-517-9713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty