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General NPI Number Information
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NPI Number | 1861565244
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Entity Type | Organization
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Legal Business Name | UPSTATE SPINE & WELLNESS, LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1389 BRUSHY CREEK RD
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City | TAYLORS
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State | SC
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Zip | 29687-4081
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Country | US
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Telephone | 864-230-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 OLD SPARTANBURG RD #168
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City | GREER
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State | SC
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Zip | 29650-2704
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Country | US
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Telephone | 864-275-6700
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. DANIEL LANCIANESE
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Credential |
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Telephone | 864-275-6700
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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 | 1396
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License Number State | SC
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