Provider Demographics
NPI:1437220944
Name:NODRICK, DEBORAH M (DC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:NODRICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2935
Mailing Address - Country:US
Mailing Address - Phone:843-841-3911
Mailing Address - Fax:843-841-3912
Practice Address - Street 1:500 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2935
Practice Address - Country:US
Practice Address - Phone:843-841-3911
Practice Address - Fax:843-841-3912
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2219111N00000X
NC2615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11656195OtherUNIVERSAL CREDENTIALING