Provider Demographics
NPI:1710905765
Name:EMERALD CITY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EMERALD CITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:ONCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-223-2224
Mailing Address - Street 1:423B CALHOUN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-2015
Mailing Address - Country:US
Mailing Address - Phone:864-223-2224
Mailing Address - Fax:864-223-2225
Practice Address - Street 1:423B CALHOUN AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-2015
Practice Address - Country:US
Practice Address - Phone:864-223-2224
Practice Address - Fax:864-223-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3107Medicaid