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General NPI Number Information
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NPI Number | 1417537457
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Entity Type | Organization
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Legal Business Name | CLINTON CRACK HOUSE
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 209 MUSGROVE ST
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City | CLINTON
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State | SC
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Zip | 29325-2347
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Country | US
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Telephone | 864-547-2250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | CLINTON
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State | SC
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Zip | 29325-0209
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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 | DIRECTOR
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Name | RYAN WILLIAMS
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Credential | DC
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Telephone | 864-547-2250
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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 |
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License Number State |
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