Provider Demographics
NPI:1679819726
Name:BROYLES CHIROPRACTIC AND SPORTS MEDICINE PA
Entity Type:Organization
Organization Name:BROYLES CHIROPRACTIC AND SPORTS MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-313-6094
Mailing Address - Street 1:9945 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7134
Mailing Address - Country:US
Mailing Address - Phone:803-802-8601
Mailing Address - Fax:803-802-7969
Practice Address - Street 1:9945 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7134
Practice Address - Country:US
Practice Address - Phone:803-082-8601
Practice Address - Fax:803-802-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty