=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811636988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIDENT HEALTH AND CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2022
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 AZALEA CT
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29301-6554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-871-4951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1955 DRAYTON RD # 1468
-----------------------------------------------------
City | DRAYTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29333-9802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-871-4951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. KYLE GARBART
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 864-871-4951
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NX0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------