Healthcare Provider Details

I. General information

NPI: 1902334345
Provider Name (Legal Business Name): TYLER LEE MAXEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W RUTLEDGE AVE
GAFFNEY SC
29340-2232
US

IV. Provider business mailing address

111 W RUTLEDGE AVE
GAFFNEY SC
29340-2232
US

V. Phone/Fax

Practice location:
  • Phone: 864-489-2444
  • Fax: 864-489-6948
Mailing address:
  • Phone: 864-489-2444
  • Fax: 864-489-6948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4238
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number4238
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: