Provider Demographics
NPI:1417911355
Name:BRIDGES, EDDIE VAN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:VAN
Last Name:BRIDGES
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 1:2084 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1425
Mailing Address - Country:US
Mailing Address - Phone:864-542-1066
Mailing Address - Fax:864-542-0780
Practice Address - Street 1:2084 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1425
Practice Address - Country:US
Practice Address - Phone:864-542-1066
Practice Address - Fax:864-542-0780
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1490Medicaid
SCCH1490Medicaid