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General NPI Number Information
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NPI Number | 1346635752
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Entity Type | Organization
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Legal Business Name | PRO CHIROPRACTIC AND PERFORMANCE, LLC.
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 1014 LEESBURG RD
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City | COLUMBIA
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State | SC
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Zip | 29209-2131
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Country | US
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Telephone | 803-309-3777
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Fax |
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Provider Business Mailing Address
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Address Line | 150 PELHAM DR
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City | COLUMBIA
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State | SC
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Zip | 29209-1320
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Country | US
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Telephone | 803-227-3377
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Fax | 803-227-4884
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK RYAN OTOOLE
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Credential | D.C.
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Telephone | 803-309-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 3877
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License Number State | SC
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