Provider Demographics
NPI:1295119063
Name:SPINE CENTERS OF SOUTH CAROLINA, LLP
Entity type:Organization
Organization Name:SPINE CENTERS OF SOUTH CAROLINA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SITNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:803-587-8027
Mailing Address - Street 1:4731 W ATLANTIC AVE # B21
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3897
Mailing Address - Country:US
Mailing Address - Phone:803-587-8027
Mailing Address - Fax:803-587-8028
Practice Address - Street 1:131 PROFESSIONAL PARK RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7847
Practice Address - Country:US
Practice Address - Phone:803-587-8027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty