Provider Demographics
NPI:1407284870
Name:CHERRYDALE CHIROPRACTIC
Entity type:Organization
Organization Name:CHERRYDALE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-319-5207
Mailing Address - Street 1:2400 N PLEASANTBURG DR STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2706
Mailing Address - Country:US
Mailing Address - Phone:864-268-9040
Mailing Address - Fax:864-272-3987
Practice Address - Street 1:2400 N PLEASANTBURG DR STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2706
Practice Address - Country:US
Practice Address - Phone:864-268-9040
Practice Address - Fax:864-272-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty