Healthcare Provider Details

I. General information

NPI: 1477538551
Provider Name (Legal Business Name): DAVID G REDDING DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 CHARLOTTE HWY STE 9
LAKE WYLIE SC
29710-7057
US

IV. Provider business mailing address

4543 CHARLOTTE HWY STE 9
LAKE WYLIE SC
29710-7057
US

V. Phone/Fax

Practice location:
  • Phone: 803-701-7077
  • Fax: 803-620-4812
Mailing address:
  • Phone: 803-701-7077
  • Fax: 803-620-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007233
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3169
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4080
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: