Provider Demographics
NPI:1407906290
Name:POPWELL SCOTA SPINE CENTER
Entity Type:Organization
Organization Name:POPWELL SCOTA SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN & PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-244-2220
Mailing Address - Street 1:107 PELHAM COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4974
Mailing Address - Country:US
Mailing Address - Phone:864-244-2220
Mailing Address - Fax:864-244-9282
Practice Address - Street 1:107 PELHAM COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4974
Practice Address - Country:US
Practice Address - Phone:864-244-2220
Practice Address - Fax:864-244-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2592111N00000X
SC2926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1336118272OtherPOPWELL NPI
SC1780835496OtherKENYA NPI#
SC1780653204OtherSCOTA NPI
SC1336118272OtherPOPWELL NPI
DF7306Medicare PIN
SC7720Medicare PIN
SCT55852Medicare UPIN