Provider Demographics
NPI:1972756187
Name:WEST END CHIROPRACTIC OF THE UPSTATE, LLC
Entity type:Organization
Organization Name:WEST END CHIROPRACTIC OF THE UPSTATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLASSENGALE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:864-232-5488
Mailing Address - Street 1:713 PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3321
Mailing Address - Country:US
Mailing Address - Phone:864-232-5488
Mailing Address - Fax:864-232-7388
Practice Address - Street 1:713 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3321
Practice Address - Country:US
Practice Address - Phone:864-232-5488
Practice Address - Fax:864-232-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1782Medicaid