Provider Demographics
NPI:1629429220
Name:CONVERSE CHIROPRACTIC
Entity type:Organization
Organization Name:CONVERSE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-401-9647
Mailing Address - Street 1:515 E SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1625
Mailing Address - Country:US
Mailing Address - Phone:864-699-9990
Mailing Address - Fax:
Practice Address - Street 1:515 E SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1625
Practice Address - Country:US
Practice Address - Phone:864-699-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty