Provider Demographics
NPI:1841630878
Name:TREE OF LIFE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:TREE OF LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TREMAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-728-6766
Mailing Address - Street 1:PO BOX 50621
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-0621
Mailing Address - Country:US
Mailing Address - Phone:803-728-6766
Mailing Address - Fax:
Practice Address - Street 1:110 WILDEWOOD PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4301
Practice Address - Country:US
Practice Address - Phone:803-728-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750721700OtherINDIVIDUAL NPI