Provider Demographics
NPI:1407187560
Name:RALLS, SAMUEL ISAIAH (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ISAIAH
Last Name:RALLS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5073 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-8005
Mailing Address - Country:US
Mailing Address - Phone:864-327-9413
Mailing Address - Fax:864-327-9413
Practice Address - Street 1:5073 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-8005
Practice Address - Country:US
Practice Address - Phone:864-327-9413
Practice Address - Fax:864-327-9413
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2413111N00000X
SC3597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor