Healthcare Provider Details

I. General information

NPI: 1952347320
Provider Name (Legal Business Name): PHILIP EDWARD BRAFFORD JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 W CHEROKEE STREET
BLACKSBURG SC
29702
US

IV. Provider business mailing address

1742 W CHEROKEE STREET
BLACKSBURG SC
29702
US

V. Phone/Fax

Practice location:
  • Phone: 864-839-2776
  • Fax: 864-839-2776
Mailing address:
  • Phone: 864-839-2776
  • Fax: 864-839-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2277
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3095
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: