Provider Demographics
NPI:1588878425
Name:BL SPINE
Entity type:Organization
Organization Name:BL SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-332-2663
Mailing Address - Street 1:PO BOX 3254
Mailing Address - Street 2:365 E COLUMBIA AVE
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070
Mailing Address - Country:US
Mailing Address - Phone:803-332-2663
Mailing Address - Fax:803-332-2663
Practice Address - Street 1:365 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070
Practice Address - Country:US
Practice Address - Phone:803-332-2663
Practice Address - Fax:803-332-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U948107601Medicare UPIN