Provider Demographics
NPI:1801556485
Name:PURE LIGHT CHIROPRACTIC - LASER LIGHT THERAPY
Entity type:Organization
Organization Name:PURE LIGHT CHIROPRACTIC - LASER LIGHT THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HOOMANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-477-3910
Mailing Address - Street 1:3921 SC-14
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-477-3910
Mailing Address - Fax:
Practice Address - Street 1:3921 SC-14
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-477-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty