NPIMap

Organization Active NPI

Primecare of the Lower Pee Dee LLC

  • Chiropractor
  • Lake City, SC
National Provider Identifier
1972044758
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PRIMECARE OF THE LOWER PEE DEE LLC
Practice address
263 Kelley St
Ste 100
Lake City, SC 29560-2472
Phone
(843) 394-8274
Fax
(843) 394-1604
NPI assigned
Mar 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Authorized official

Name
Tyrone D WallaceNPI 1780633420
Title
Owner/Provider
Phone
(843) 394-8274

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
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X SC Primary

Addresses

Primary practice location

263 Kelley St
Ste 100
Lake City, SC 29560-2472

Mailing address

263 Kelley St
Ste 100
Lake City, SC 29560-2472
Phone (843) 394-8274

National Provider Directory

National Provider Directory

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": "1489449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1972044758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 KELLEY ST",
            "address_2": "STE 100",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602472",
            "telephone_number": "843-394-8274",
            "fax_number": "843-394-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 KELLEY ST",
            "address_2": "STE 100",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602472",
            "telephone_number": "843-394-8274",
            "fax_number": "843-394-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE OF THE LOWER PEE DEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-14",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TYRONE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "843-394-8274"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; 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.