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General NPI Number Information
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NPI Number | 1104028810
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Entity Type | Organization
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Legal Business Name | CAROLINA FOOT CARE LLC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 1399 JOHN B WHITE SR BLVD
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City | SPARTANBURG
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State | SC
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Zip | 29306-3911
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Country | US
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Telephone | 864-595-9300
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Fax | 864-595-9400
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Provider Business Mailing Address
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Address Line | 1399 JOHN B WHITE SR BLVD
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City | SPARTANBURG
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State | SC
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Zip | 29306-3911
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MICHAEL J JORDAN
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Credential | DPM
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Telephone | 864-595-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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