Provider Demographics
NPI:1477538551
Name:REDDING, DAVID G (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:REDDING
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 1:4543 CHARLOTTE HWY STE 9
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-7057
Mailing Address - Country:US
Mailing Address - Phone:803-701-7077
Mailing Address - Fax:803-620-4812
Practice Address - Street 1:4543 CHARLOTTE HWY STE 9
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-7057
Practice Address - Country:US
Practice Address - Phone:803-701-7077
Practice Address - Fax:803-620-4812
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007233111N00000X
NC3169111N00000X
SC4080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC18-1837267OtherBLUE CROSS BLUE SHIELD
NYP010007233OtherBLUE CHOICE PROV ID
NYP020007233OtherBLUECROSS BLUE SHIELD
NYP020007233OtherBLUECROSS BLUE SHIELD
NYP010007233OtherBLUE CHOICE PROV ID