Provider Demographics
NPI:1528940418
Name:NORTHSIDE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:NORTHSIDE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-359-1891
Mailing Address - Street 1:5013 OLD BUNCOMBE RD STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-8214
Mailing Address - Country:US
Mailing Address - Phone:864-539-1868
Mailing Address - Fax:
Practice Address - Street 1:5013 OLD BUNCOMBE RD STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-8214
Practice Address - Country:US
Practice Address - Phone:864-539-1868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty