Provider Demographics
NPI:1013300722
Name:MODLIN, THADDEUS (DC)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:
Last Name:MODLIN
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 1:27 S PLEASANTBURG DR STE 60
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2574
Mailing Address - Country:US
Mailing Address - Phone:864-605-7350
Mailing Address - Fax:864-605-7351
Practice Address - Street 1:27 S PLEASANTBURG DR STE 60
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2574
Practice Address - Country:US
Practice Address - Phone:864-605-7350
Practice Address - Fax:864-605-7351
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor