Provider Demographics
NPI:1982739447
Name:BRELAND, ROXZANNE BEASON (DC)
Entity Type:Individual
Prefix:
First Name:ROXZANNE
Middle Name:BEASON
Last Name:BRELAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 POPLAR DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6602
Mailing Address - Country:US
Mailing Address - Phone:864-569-8221
Mailing Address - Fax:
Practice Address - Street 1:1610 POPLAR DRIVE EXT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6602
Practice Address - Country:US
Practice Address - Phone:864-228-0047
Practice Address - Fax:864-963-0870
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1053Medicaid
SCT244620281Medicare ID - Type Unspecified
SCCH1053Medicaid