Healthcare Provider Details

I. General information

NPI: 1952613770
Provider Name (Legal Business Name): SENECA HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BYPASS HIGHWAY 123 STE C
SENECA SC
29678-0810
US

IV. Provider business mailing address

555 BYPASS HIGHWAY 123 SUITE C
SENECA SC
29678-0809
US

V. Phone/Fax

Practice location:
  • Phone: 864-888-0039
  • Fax: 864-888-0034
Mailing address:
  • Phone: 864-888-0039
  • Fax: 864-888-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1287
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29413
License Number StateSC

VIII. Authorized Official

Name: DR. GARRY VAN ROMER
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 864-888-0039