Provider Demographics
NPI:1396015657
Name:DOVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DOVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-220-2882
Mailing Address - Street 1:3403 WHITE HORSE RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-5946
Mailing Address - Country:US
Mailing Address - Phone:864-220-2882
Mailing Address - Fax:864-220-2815
Practice Address - Street 1:3403 WHITE HORSE RD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-5946
Practice Address - Country:US
Practice Address - Phone:864-220-2882
Practice Address - Fax:864-220-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty