Provider Demographics
NPI:1497041529
Name:GREENVILLE SPINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:GREENVILLE SPINE INSTITUTE, LLC
Other - Org Name:LIFESPAN CHIROPRACTIC CENTERS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-631-1420
Mailing Address - Street 1:1190 HAYWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2282
Mailing Address - Country:US
Mailing Address - Phone:864-631-1420
Mailing Address - Fax:864-631-1459
Practice Address - Street 1:1190 HAYWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2282
Practice Address - Country:US
Practice Address - Phone:864-631-1420
Practice Address - Fax:864-631-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty