Provider Demographics
NPI:1487815114
Name:CAROLINA SPINE & REHAB LLC
Entity Type:Organization
Organization Name:CAROLINA SPINE & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-268-3400
Mailing Address - Street 1:1318 HAYWOOD RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4992
Mailing Address - Country:US
Mailing Address - Phone:864-268-3400
Mailing Address - Fax:864-268-4526
Practice Address - Street 1:1318 HAYWOOD RD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4992
Practice Address - Country:US
Practice Address - Phone:864-268-3400
Practice Address - Fax:864-268-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty