Healthcare Provider Details

I. General information

NPI: 1063360675
Provider Name (Legal Business Name): ACACIA CHIROPRACTIC CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 STONECREST BLVD STE 102
FORT MILL SC
29708-6633
US

IV. Provider business mailing address

10017 GLENCREST DR
HUNTERSVILLE NC
28078-5258
US

V. Phone/Fax

Practice location:
  • Phone: 803-412-2240
  • Fax: 803-802-2413
Mailing address:
  • Phone: 803-412-2240
  • Fax: 803-802-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JARED SAMS
Title or Position: OWNER
Credential:
Phone: 803-412-2240