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General NPI Number Information
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NPI Number | 1932420098
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Entity Type | Organization
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Legal Business Name | GREENVILLE FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 21 ORCHARD PARK DR SUITE E-2
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City | GREENVILLE
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State | SC
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Zip | 29615-3528
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Country | US
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Telephone | 864-213-9919
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Fax | 864-213-9918
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Provider Business Mailing Address
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Address Line | 21 ORCHARD PARK DR SUITE E-2
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City | GREENVILLE
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State | SC
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Zip | 29615-3528
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Country | US
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Telephone | 864-213-9919
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Fax | 864-213-9918
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DEREK COLLIN CLEM
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Credential | D.C.
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Telephone | 864-213-9919
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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 | 3551
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License Number State | SC
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