Provider Demographics
NPI:1679755300
Name:UNDERWOOD, DAVID CHAD (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHAD
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11631 ASHEVILLE HWY
Mailing Address - Street 2:SUITE I
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-1812
Mailing Address - Country:US
Mailing Address - Phone:864-473-0242
Mailing Address - Fax:864-472-0373
Practice Address - Street 1:11631 ASHEVILLE HWY
Practice Address - Street 2:SUITE I
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-1812
Practice Address - Country:US
Practice Address - Phone:864-473-0242
Practice Address - Fax:864-472-0373
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3312Medicaid