Wallace, Tyrone D
Wallace, Tyrone D is an sole proprietor health care provider with primary practice located at 263 Kelley St Ste 100, Lake City SC 29560-2450. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Wallace, Tyrone D can be contacted via phone (843) 394-8274.Contact Information
Primary practice address
263 Kelley St Ste 100
Lake City SC 29560-2450
Phone: (843) 394-8274
Fax: (843) 394-1604
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 1873 | South Carolina |
Profile Details
| NPI number | 1780633420 |
|---|---|
| LBN Legal business name | Wallace, Tyrone D |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 9th, 2006 |
| Last updated | Dec 7th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780633420 | NPPES |
| South Carolina | MEDICAID | CH1873 | |
| South Carolina | Other | 571012172 |
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