=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063698835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICARE BACK CTR.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2008
-----------------------------------------------------
Last Update Date | 01/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 MILLS AVE STE E
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-4280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-233-3364
-----------------------------------------------------
Fax | 864-233-3464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 MILLS AVE STE E
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-4280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-233-3364
-----------------------------------------------------
Fax | 864-233-3464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JERRY C. LANGLEY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 864-233-3364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 781
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------