Provider Demographics
NPI:1760448344
Name:PROFESSIONAL CHIROPRACTIC SERVICES PA
Entity Type:Organization
Organization Name:PROFESSIONAL CHIROPRACTIC SERVICES PA
Other - Org Name:BELUE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BELUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-585-2600
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29305
Mailing Address - Country:US
Mailing Address - Phone:864-585-2600
Mailing Address - Fax:864-585-5643
Practice Address - Street 1:813 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-585-2600
Practice Address - Fax:864-585-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4052Medicare PIN