MEDICARE: LAKE WYLIE FAMILY CHIROPRACTIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2361	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891893798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE WYLIE FAMILY CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	244 LATITUDE LN
Second Line	:	SUITE 104
City	:	CLOVER
State	:	SC
Zip	:	29710-8124
Country	:	US
Telephone Number	:	803-831-6500
Fax Number	:	803-831-6383

Provider Business Practice Location Address
First Line	:	244 LATITUDE LN
Second Line	:	SUITE 104
City	:	CLOVER
State	:	SC
Zip	:	29710-8124
Country	:	US
Telephone Number	:	803-831-6500
Fax Number	:	803-831-6383

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN D HARTLEY
Credential	:	PH.D., DC
Telephone Number	:	803-831-6500

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/11/2012

Similar Medicare Providers

1992913362 — DR. VANESSA N VARGAS DMD
Practice Location Address:

244 LATITUDE LN , SUITE 103
CLOVER, SC
29710-8124

Practice Phone: 803-810-2211
Practice Fax:

1922756659 — TROY SANDERS
Practice Location Address:

8045 SWEET CLOVER CT
LAS VEGAS, NV
89131-8124

Practice Phone: 725-232-1847
Practice Fax:

1275576472 — DR. ALAN DAVID HARTLEY PH.D., DC
Practice Location Address:

244 LATITUDE LN , SUITE 104
LAKE WYLIE, SC
29710-8124

Practice Phone: 803-831-6500
Practice Fax: 803-831-6383

1932599693 — DR. AMBER MARIE PEDERSON D.C.
Practice Location Address:

244 LATITUDE LN , UNIT 104
LAKE WYLIE, SC
29710-8124

Practice Phone: 803-831-6500
Practice Fax: 803-831-6383

1124982186 — AMELIA BELLAH WOART
Practice Location Address:

4017 SHASTA CIR
CLOVER, SC
29710-6912

Practice Phone: 704-963-8691
Practice Fax:

1164454609 — DR. NAZILA ESHRAGHI DPM
Practice Location Address:

5 EXECUTIVE CT # 102
CLOVER, SC
29710-9338

Practice Phone: 803-693-2425
Practice Fax: 833-989-2166

Directions to “LAKE WYLIE FAMILY CHIROPRACTIC INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.