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General NPI Number Information
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NPI Number | 1962799692
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Entity Type | Organization
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Legal Business Name | SPINE AND JOINT, LLC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 105 S MAPLE ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2629
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Country | US
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Telephone | 864-547-2250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | CLINTON
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State | SC
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Zip | 29325-0209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN V WILLIAMS
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Credential | D.C., UCA
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Telephone | 864-547-2250
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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 | 3524
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License Number State | SC
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