Healthcare Provider Details

I. General information

NPI: 1164452926
Provider Name (Legal Business Name): DEGRAAF CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 EDGEFIELD RD
NORTH AUGUSTA SC
29841-2486
US

IV. Provider business mailing address

244 EDGEFIELD RD
NORTH AUGUSTA SC
29841-2486
US

V. Phone/Fax

Practice location:
  • Phone: 803-279-3360
  • Fax: 803-279-9440
Mailing address:
  • Phone: 803-279-3360
  • Fax: 803-279-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GLENN C DEGRAAF
Title or Position: OWNER -CHIROPRACTOR
Credential: DC
Phone: 803-279-3360