=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225434731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMSTEAD CHIROPRACTIC CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2014
-----------------------------------------------------
Last Update Date | 11/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 SE MAIN ST SUITE 200
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29681-2673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-881-3693
-----------------------------------------------------
Fax | 864-881-3693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 SE MAIN ST SUITE 200
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29681-2673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-881-3693
-----------------------------------------------------
Fax | 864-881-3693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. ALLIE SANSBURY HAMSTEAD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 864-590-0845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3731
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------