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General NPI Number Information
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NPI Number | 1467625319
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Entity Type | Organization
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Legal Business Name | TRI-CARE CLINIC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 2701 WOODRUFF ROAD SUITE C
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3640
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Country | US
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Telephone | 864-213-9505
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Fax | 864-213-9506
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Provider Business Mailing Address
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Address Line | 2607 WOODRUFF ROAD SUITE E #334
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3640
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Country | US
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Telephone | 864-884-5906
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MR. CARL DEWAYNE BRINKMAN
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Credential | DC
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Telephone | 864-884-5906
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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 | 2854
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2854SC
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License Number State | SC
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