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General NPI Number Information
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NPI Number | 1467688143
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Entity Type | Organization
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Legal Business Name | DR. MIKES CHIROPRACTIC
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 4200 E NORTH ST SUTIE 6
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City | GREENVILLE
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State | SC
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Zip | 29615-2437
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Country | US
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Telephone | 864-244-4123
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Fax | 864-244-6879
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Provider Business Mailing Address
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Address Line | 4200 E NORTH ST SUTIE 6
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City | GREENVILLE
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State | SC
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Zip | 29615-2437
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Country | US
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Telephone | 864-244-4123
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Fax | 864-244-6879
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL J LAMASCOLO
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Credential | D.C
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Telephone | 864-244-4123
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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 | 2939
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License Number State | SC
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