Provider Demographics
NPI:1871854380
Name:CAROLINA SPINE LLC
Entity Type:Organization
Organization Name:CAROLINA SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-548-8100
Mailing Address - Street 1:8451 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7587
Mailing Address - Country:US
Mailing Address - Phone:803-548-8100
Mailing Address - Fax:803-548-8111
Practice Address - Street 1:8451 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7587
Practice Address - Country:US
Practice Address - Phone:803-548-8100
Practice Address - Fax:803-548-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA8820B205Medicare PIN