TYRONE D WALLACE (NPI# 1780633420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780633420 |
| Entity Type | Individual |
| Full Name | TYRONE D WALLACE |
| Credential | DC |
| Practice Address |
263 Kelley St Ste 100 Lake City SC 29560-2450 |
| Practice Telephone | 8433948274 |
| Practice Fax Number | 8433941604 |
| Mailing Telephone | 8433948274 |
| Mailing Fax Number | 8433941604 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2016-12-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 1873 | SC | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | CH1873 | 05 | |
| SC | BC | 571012172 | 01 |
| Street Address |
263 KELLEY ST STE 100 |
| City | LAKE CITY |
| State | SC |
| Zip Code | 29560-2450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972044758 | Primecare of The Lower Pee Dee LLC | Chiropractor | 263 Kelley St, Ste 100, Lake City, SC 29560-2472 | 2017-03-14 |
| 1013188531 | Wallace Chiropractic and Spinal Rehab, LLC | Chiropractor | 263 Kelley St, Suite 100, Lake City, SC 29560-2472 | 2008-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457830366 | Patty Fulmore | In Home Supportive Care | 141 Bulldog Lane, Lake City, SC 29560 | 2018-08-10 |
| 1558875211 | Msk Transportation | Non-emergency Medical Transport (VAN) | 226 Lake Dale Ave, Lake City, SC 29560 | 2017-11-16 |
| 1861867566 | Denita Alison Pleasant | Pharmacist | 301 West Thomas Street, Lake City, SC 29560 | 2015-12-07 |
| 1821474115 | Pro-motion Physical Therapy of Florence, Sc, LLC | Occupational Therapist | 148 B Sauls Street, Lake City, SC 29560 | 2015-08-10 |
| 1023412335 | Motivations-unlimited | Speech-Language Pathologist | 318 A Moore Street, Lake City, SC 29560 | 2014-10-15 |
| 1700297652 | Sharon Lewis | Pharmacist | 900 Us Highway 52, Lake City, SC 29560 | 2014-05-14 |
| 1376954305 | Sergio Montes | Pharmacist | 900 Us Hwy 52, Lake City, SC 29560 | 2014-05-13 |
| 1992122857 | Paula Moses | Pharmacist | 900 U.s Hwy. 52, Lake City, SC 29560 | 2014-03-27 |
| 1063762763 | Dawn Mcelveen Floyd | Pharmacist | 301 W Thomas Street, Lake City, SC 29560 | 2012-09-11 |
| 1548519507 | Robert Bruce Page | Pharmacist | 401 West Thomas St, Lake City, SC 29560 | 2012-09-06 |
| Find all providers in zip 29560 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194295592 | Joshua M Wilson | Chiropractor | 444 Sw Alachua Avenue, Lake City, FL 32025-5213 | 2018-11-28 |
| 1487018222 | Lake City Spine & Injury, LLC | Chiropractor | 2057 Sw Main Blvd, Lake City, FL 32025-0021 | 2016-04-07 |
| 1841656527 | Chucky Sentell Jordan | Chiropractor | 263 Kelley St Ste 100, Lake City, SC 29560-2472 | 2016-01-11 |
| 1811179781 | Lake City Chiropractic and Massage | Chiropractor | 512 W Duval St, Lake City, FL 32055-3899 | 2007-12-03 |
| 1003000415 | Marshall Dean Webster | Chiropractor | 1478 Sw Sisters Welcome Rd, Lake City, FL 32025-1607 | 2007-08-29 |
| 1649481052 | Larry Fredric Radke | Chiropractor | 430 Sw Columbia Ave, Lake City, FL 32025-5254 | 2007-05-25 |
| 1356481386 | Shawn A Stephens | Chiropractor | 935 Sw Baya Dr, Lake City, FL 32025-4210 | 2007-02-07 |
| 1033266317 | Nathan Troy Schulz | Chiropractor | 925 S Oak St, Lake City, MN 55041-1856 | 2007-01-05 |
| 1205990066 | Terrell E Fowler IIi | Chiropractor | 111 N Matthews Rd, Lake City, SC 29560-2309 | 2006-12-19 |
| 1497813083 | Leroy Frank Otto | Chiropractor | 127 South High Street, Lake City, MN 55041-1637 | 2006-12-05 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.