Provider Demographics
NPI:1891764767
Name:RADCLIFF, RONN CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:RONN
Middle Name:CHARLES
Last Name:RADCLIFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S GRANARD ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2346
Mailing Address - Country:US
Mailing Address - Phone:864-489-7246
Mailing Address - Fax:864-489-8307
Practice Address - Street 1:122 S GRANARD ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2346
Practice Address - Country:US
Practice Address - Phone:864-489-7246
Practice Address - Fax:864-489-8307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085RPMedicaid
SCCH2330Medicaid
SCGCH313Medicaid
SCGCH313Medicaid