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General NPI Number Information
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NPI Number | 1114183860
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Entity Type | Organization
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Legal Business Name | MIDLANDS SPECIFIC CHIROPRACTIC
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 1100 ROSE STREET SUITE A&B
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City | ELGIN
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State | SC
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Zip | 29045
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Country | US
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Telephone | 803-408-2303
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1118
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City | ELGIN
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State | SC
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Zip | 29045-1118
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Country | US
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Telephone | 803-408-2303
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRENCE MICHAEL DEMETER
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Credential | D.C.
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Telephone | 678-571-1265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3317
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License Number State | SC
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