Provider Demographics
NPI:1558527713
Name:TRI-CARE CLINIC
Entity Type:Organization
Organization Name:TRI-CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-884-5906
Mailing Address - Street 1:2607 WOODRUFF RD
Mailing Address - Street 2:SUITE E #334
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3640
Mailing Address - Country:US
Mailing Address - Phone:864-884-5906
Mailing Address - Fax:
Practice Address - Street 1:2701 WOODRUFF RD
Practice Address - Street 2:SUITE C
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3640
Practice Address - Country:US
Practice Address - Phone:864-213-9505
Practice Address - Fax:864-213-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2854SC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCV03029Medicare UPIN
SC8141Medicare PIN