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General NPI Number Information
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NPI Number | 1558318667
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Entity Type | Organization
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Legal Business Name | ACTIVE FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2410 HWY 72 221 E
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City | GREENWOOD
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State | SC
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Zip | 29649-9722
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Country | US
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Telephone | 864-223-2236
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Fax | 864-223-2246
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Provider Business Mailing Address
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Address Line | PO BOX 50091
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City | GREENWOOD
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State | SC
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Zip | 29649-0019
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Country | US
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Telephone | 864-223-2236
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Fax | 864-223-2246
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. SHANA L SULLIVAN
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Credential | D.C.
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Telephone | 864-223-2236
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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 | 3109
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License Number State | SC
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