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General NPI Number Information
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NPI Number | 1487815114
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Entity Type | Organization
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Legal Business Name | CAROLINA SPINE & REHAB LLC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 1318 HAYWOOD RD STE C
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City | GREENVILLE
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State | SC
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Zip | 29615-4992
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Country | US
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Telephone | 864-268-3400
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Fax | 864-268-4526
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Provider Business Mailing Address
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Address Line | 1318 HAYWOOD RD STE C
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City | GREENVILLE
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State | SC
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Zip | 29615-4992
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Country | US
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Telephone | 864-268-3400
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Fax | 864-268-4526
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Authorized Official
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Title or Position | CO-OWNER
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Name | MICHAEL C. SHRIDE
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Credential | DC
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Telephone | 864-268-3400
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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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