Healthcare Provider Details

I. General information

NPI: 1134312630
Provider Name (Legal Business Name): YOUR FAMILYS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W MAIN ST
DUNCAN SC
29334-9369
US

IV. Provider business mailing address

68 GLOBAL DR SUITE 100
GREENVILLE SC
29607-4628
US

V. Phone/Fax

Practice location:
  • Phone: 864-949-5550
  • Fax: 864-949-5551
Mailing address:
  • Phone: 864-644-2700
  • Fax: 864-644-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J CROCKFORD
Title or Position: OWNER
Credential: DC
Phone: 864-949-5550