Provider Demographics
NPI:1669567327
Name:SIMPSONVILLE FAMILY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:SIMPSONVILLE FAMILY CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'BLENESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-962-8800
Mailing Address - Street 1:655 FAIRVIEW RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7500
Mailing Address - Country:US
Mailing Address - Phone:864-962-8800
Mailing Address - Fax:864-228-9129
Practice Address - Street 1:655 FAIRVIEW RD
Practice Address - Street 2:SUITE J
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7500
Practice Address - Country:US
Practice Address - Phone:864-962-8800
Practice Address - Fax:864-228-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH 2503111N00000X
SCCH 2296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1962527291OtherDR. O'BLENESS NPI
SC1043335102OtherDR. BOUSQUET NPI
SCGCH442Medicaid
SCGCH442Medicaid