NPIMap

Organization Active NPI

Enhanced Living Travelers Rest

  • Chiropractor
  • Travelers Rest, SC
National Provider Identifier
1063972255
Registry record updated Mar 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ENHANCED LIVING TRAVELERS REST
Practice address
148 Walnut LN Ste 1
Travelers Rest, SC 29690-1600
Phone
(864) 834-8099
NPI assigned
Mar 22, 2019
Organization subpart
Yes
Parent organization
ENHANCED LIVING CHIROPRACTICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2019

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

Authorized official

Name
Beth Allen
Title
Manager
Phone
(864) 848-0640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

148 Walnut LN Ste 1
Travelers Rest, SC 29690-1600

Mailing address

148 Walnut LN Ste 1
Travelers Rest, SC 29690-1600
Phone (864) 834-8099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190722001530 SC Part B Supplier - Clinic/Group Practice 5890021398 Receives reassigned benefits from 3 practitioners
Practice locations: Travelers Rest, SC

National Provider Directory

National Provider Directory
Part of
Enhanced Living Chiropractic

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

148 Walnut Ln
Ste 1
Travelers Rest, SC 29690
Phone (864) 834-8099

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553212800000",
    "number": "1063972255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 WALNUT LN STE 1",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296901600",
            "telephone_number": "864-834-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 WALNUT LN STE 1",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296901600",
            "telephone_number": "864-834-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENHANCED LIVING TRAVELERS REST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENHANCED LIVING CHIROPRACTIC",
        "enumeration_date": "2019-03-22",
        "last_updated": "2019-03-22",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "864-848-0640"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Travelers Rest, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.