Provider Demographics
NPI:1811945686
Name:BELUE, C. DERRICK (DC)
Entity type:Individual
Prefix:
First Name:C. DERRICK
Middle Name:
Last Name:BELUE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 N PINE ST
Mailing Address - Street 2:P.O. BOX 4439
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3128
Mailing Address - Country:US
Mailing Address - Phone:864-585-2600
Mailing Address - Fax:864-585-5643
Practice Address - Street 1:813 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3128
Practice Address - Country:US
Practice Address - Phone:864-585-2600
Practice Address - Fax:864-585-5643
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1369Medicaid
SCCH1369Medicaid
SC4052Medicare PIN