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General NPI Number Information
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NPI Number | 1134160054
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Entity Type | Organization
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Legal Business Name | DAIL CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 1655 BROAD RIVER RD
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City | COLUMBIA
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State | SC
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Zip | 29210-7395
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Country | US
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Telephone | 803-772-8680
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Fax | 803-772-5241
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Provider Business Mailing Address
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Address Line | 1655 BROAD RIVER RD
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City | COLUMBIA
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State | SC
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Zip | 29210-7303
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Country | US
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Telephone | 803-772-8680
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Fax | 803-772-5241
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY EUGENE DAIL JR.
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Credential | DC
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Telephone | 803-772-8680
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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 | C0583
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License Number State | SC
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