Provider Demographics
NPI:1699838052
Name:NODRICK CHIROPRACTIC AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:NODRICK CHIROPRACTIC AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:NODRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-841-3911
Mailing Address - Street 1:500 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2935
Mailing Address - Country:US
Mailing Address - Phone:843-841-3911
Mailing Address - Fax:843-841-3912
Practice Address - Street 1:500 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2935
Practice Address - Country:US
Practice Address - Phone:843-841-3911
Practice Address - Fax:843-841-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA16768669Medicare PIN