Provider Demographics
NPI:1255646196
Name:SANTIAGO, LAD (DC, NMD, PMD, DCCN,)
Entity type:Individual
Prefix:DR
First Name:LAD
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DC, NMD, PMD, DCCN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:FAIRFOREST
Mailing Address - State:SC
Mailing Address - Zip Code:29336-0825
Mailing Address - Country:US
Mailing Address - Phone:864-084-6294
Mailing Address - Fax:864-804-6295
Practice Address - Street 1:2932 REIDVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5671
Practice Address - Country:US
Practice Address - Phone:864-804-6294
Practice Address - Fax:864-804-6295
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1864111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition