NPIMap

Organization Active NPI

Wildewood Chiropractic Center

  • Rehabilitation Chiropractor
  • Elgin, SC
National Provider Identifier
1609088376
Registry record updated Feb 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
2359 Issued in SC
Legal business name
WILDEWOOD CHIROPRACTIC CENTER
Practice address
130 Pontiac Business Center Dr
Suite a
Elgin, SC 29045-9171
Phone
(803) 865-2800
NPI assigned
May 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2009

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

Authorized official

Name
Dr. Lee Epperson, D.C.NPI 1275677841
Title
Owner
Phone
(803) 865-2800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NR0400X 2359 SC Primary

Addresses

Primary practice location

130 Pontiac Business Center Dr
Suite a
Elgin, SC 29045-9171

Mailing address

130 Pontiac Business Center Dr
Suite a
Elgin, SC 29045-9171
Phone (803) 865-2800

Other identifiers 4

IdentifierTypeStateIssuer
P00030172OtherSCRR MEDICARE
CH2359MedicaidSC
2359OtherSCSC LICENSE NUMBER
7279211OtherSCAETNA

National Provider Directory

National Provider Directory

Locations

130 Pontiac Business Center Dr
#A
Elgin, SC 29045
Phone (803) 865-2800

Practitioners & affiliated clinicians

Practitioners 1

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": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1609088376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 PONTIAC BUSINESS CENTER DR",
            "address_2": "SUITE A",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "290459171",
            "telephone_number": "803-865-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PONTIAC BUSINESS CENTER DR",
            "address_2": "SUITE A",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "290459171",
            "telephone_number": "803-865-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDEWOOD CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "EPPERSON",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-865-2800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "SC",
            "license": "2359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00030172",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2359",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC LICENSE NUMBER",
            "identifier": "2359",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7279211",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.