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General NPI Number Information
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NPI Number | 1679785638
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Entity Type | Organization
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Legal Business Name | EASTSIDE CHIROPRACTIC, PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3014 WADE HAMPTON BLVD
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City | TAYLORS
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State | SC
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Zip | 29687-2716
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Country | US
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Telephone | 864-292-6777
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Fax | 864-292-5392
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Provider Business Mailing Address
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Address Line | 3014 WADE HAMPTON BLVD
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City | TAYLORS
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State | SC
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Zip | 29687-2716
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Country | US
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Telephone | 864-292-6777
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Fax | 864-292-5392
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID H MRUZ
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Credential | D.C.
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Telephone | 864-292-6777
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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 | 832
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License Number State | SC
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