Provider Demographics
NPI:1871891598
Name:MOUNTAIN VIEW CHIROPRACTIC
Entity type:Organization
Organization Name:MOUNTAIN VIEW CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-848-4992
Mailing Address - Street 1:1605 LOCUST HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6075
Mailing Address - Country:US
Mailing Address - Phone:864-848-4992
Mailing Address - Fax:864-848-4997
Practice Address - Street 1:1605 LOCUST HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6075
Practice Address - Country:US
Practice Address - Phone:864-848-4992
Practice Address - Fax:864-848-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1356443030OtherNATIONAL PROVIDER IDENTIFIER