Three Fountains Chiropractic, Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2108 Issued in SC

Legal business name

THREE FOUNTAINS CHIROPRACTIC, INC.

Practice address

1926 S Lake Dr
Lexington, SC 29073-8282

Phone

(803) 808-1897

NPI assigned

Oct 4, 2005

Organization subpart

No

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

Authorized official

Name

Dr. David R Gooldy, DC

Title

President

Phone

(803) 808-1897

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187913600000",
    "number": "1679560742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84428",
            "address_2": "1926 SOUTH LAKE DRIVE",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290730008",
            "telephone_number": "803-808-1897",
            "fax_number": "803-808-1297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1926 S LAKE DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290738282",
            "telephone_number": "803-808-1897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE FOUNTAINS CHIROPRACTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2007-08-24",
        "status": "A",
        "authorized_official_last_name": "GOOLDY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-808-1897",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "2108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2108",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Genelle Thompson
• Sydney Thompson
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• William Robert Thorner, DMD
• George R. Thrana, MSW, LMSW
• Thrive Wellness and Rehab, LLC
• Lindsey Autumn Thurmon, NP
• Tides of Life Home Care, LLC
• Mark E Tidsworth, M.ED.
• Claire Stevens Tidwell, MS, RDN, LD, CNSC

• Chiropractor in Lexington, SC
• Providers in Lexington, SC by specialty
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.