Prohealth Center, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

SC3561 Issued in SC

Legal business name

PROHEALTH CENTER, LLC

Practice address

500 Plaza Cir Ste J
Clinton, SC 29325-7559

Phone

(864) 681-0555

Fax

(864) 408-8675

NPI assigned

Jul 2, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin SniderNPI 1477879781

Title

Ceo

Phone

(864) 681-0555

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Lane Snider, D.C.

  • Chiropractor
  • Laurens, SC
  • NPI 1477879781

  SC

  Medicare reassignment Authorized official
• Tanner Elijah Koon, NP

  • Family Nurse Practitioner
  • Clinton, SC
  • NPI 1801671862
  NPD (past)
• Martha E Ledda, APRN

  • Acute Care Nurse Practitioner
  • Clinton, SC
  • NPI 1164659710
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530489600000",
    "number": "1366938474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PLAZA CIR STE J",
            "city": "CLINTON",
            "state": "SC",
            "postal_code": "293257559",
            "telephone_number": "864-681-0555",
            "fax_number": "864-408-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PLAZA CIR STE J",
            "city": "CLINTON",
            "state": "SC",
            "postal_code": "293257559",
            "telephone_number": "864-681-0555",
            "fax_number": "864-408-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-02",
        "last_updated": "2018-07-02",
        "status": "A",
        "authorized_official_last_name": "SNIDER",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "864-681-0555"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "SC3561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Leslie Price, CRNA
• Prisma Health-Upstate
• Prisma Health-Upstate
• Prisma Health-Upstate
• Prisma Health-Upstate
• Heather Puchel
• Kimberly B Pugh, M.D.
• Pankajkumar Ravani
• Holbrook Wyman Raynal, M.D., D.H.A.
• RCG University Division, Inc.

• All providers in Clinton, SC
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.