Provider Demographics
NPI:1962645481
Name:THERAPEUTIC CHIROPRACTIC
Entity Type:Organization
Organization Name:THERAPEUTIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DERMAN
Authorized Official - Middle Name:BYERLY
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:843-407-8657
Mailing Address - Street 1:PO BOX 16312
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29606-7312
Mailing Address - Country:US
Mailing Address - Phone:843-407-8657
Mailing Address - Fax:
Practice Address - Street 1:101 VERDAE BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3832
Practice Address - Country:US
Practice Address - Phone:864-675-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty