Provider Demographics
NPI:1699925123
Name:CECCO, VANDA GINA (DC)
Entity type:Individual
Prefix:DR
First Name:VANDA
Middle Name:GINA
Last Name:CECCO
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 1:916 W POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1455
Mailing Address - Country:US
Mailing Address - Phone:864-877-9337
Mailing Address - Fax:864-877-9323
Practice Address - Street 1:916 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1455
Practice Address - Country:US
Practice Address - Phone:864-877-9337
Practice Address - Fax:864-877-9323
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3477111N00000X
SC23189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3477OtherSC LICENSE