Provider Demographics
NPI:1427764612
Name:ACEVEDO, PATRICIA (DC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 ROPER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4724
Mailing Address - Country:US
Mailing Address - Phone:787-414-5280
Mailing Address - Fax:
Practice Address - Street 1:3501 CLEMSON BLVD STE 11
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1328
Practice Address - Country:US
Practice Address - Phone:864-301-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor