Provider Demographics
NPI:1023475753
Name:BIDWELL, SAVANNAH (DC)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:
Last Name:BIDWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 JEWELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1353
Mailing Address - Country:US
Mailing Address - Phone:803-378-7031
Mailing Address - Fax:
Practice Address - Street 1:140 SAGE CREEK WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-0957
Practice Address - Country:US
Practice Address - Phone:864-848-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor