Provider Demographics
NPI:1528032554
Name:STROUP, RAYMOND H (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:H
Last Name:STROUP
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-0432
Mailing Address - Country:US
Mailing Address - Phone:843-479-6102
Mailing Address - Fax:843-479-6103
Practice Address - Street 1:101 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2476
Practice Address - Country:US
Practice Address - Phone:843-479-6102
Practice Address - Fax:843-479-6103
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2668Medicaid
U84474Medicare UPIN