Healthcare Provider Details

I. General information

NPI: 1841353380
Provider Name (Legal Business Name): DAVID BENNETT LYTCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 TWO NOTCH RD
COLUMBIA SC
29223-7501
US

IV. Provider business mailing address

216 MANOR VIEW CT
COLUMBIA SC
29212-2330
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-0293
  • Fax: 803-699-5087
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2804
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: