Provider Demographics
NPI:1598981367
Name:SPARTANBURG CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:SPARTANBURG CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCABEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-542-0780
Mailing Address - Street 1:945 EAST MAIN STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302
Mailing Address - Country:US
Mailing Address - Phone:864-542-0780
Mailing Address - Fax:864-542-1689
Practice Address - Street 1:945 EAST MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302
Practice Address - Country:US
Practice Address - Phone:864-542-0780
Practice Address - Fax:864-542-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2834111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH541Medicaid
SCU97513Medicare UPIN
SCGCH541Medicaid