Provider Demographics
NPI:1215280581
Name:DARRAH FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:DARRAH FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TANDY
Authorized Official - Middle Name:CLEVELAND
Authorized Official - Last Name:GOSNELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:864-254-9915
Mailing Address - Street 1:1791 WOODRUFF RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5978
Mailing Address - Country:US
Mailing Address - Phone:864-254-9915
Mailing Address - Fax:864-254-9916
Practice Address - Street 1:1791 WOODRUFF RD
Practice Address - Street 2:SUITE I
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5978
Practice Address - Country:US
Practice Address - Phone:864-254-9915
Practice Address - Fax:864-254-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA45110281Medicare PIN