Provider Demographics
NPI:1720878168
Name:DETORE, SAMANTHA (DC)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:DETORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BATESBURG LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7055
Mailing Address - Country:US
Mailing Address - Phone:803-307-0000
Mailing Address - Fax:
Practice Address - Street 1:323 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:BATESBURG LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7055
Practice Address - Country:US
Practice Address - Phone:803-307-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor