Healthcare Provider Details

I. General information

NPI: 1881974756
Provider Name (Legal Business Name): LAND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 WADE HAMPTON BLVD STE B
GREENVILLE SC
29615-1148
US

IV. Provider business mailing address

2520 WADE HAMPTON BLVD STE B
GREENVILLE SC
29615-1148
US

V. Phone/Fax

Practice location:
  • Phone: 864-552-1142
  • Fax: 864-552-1143
Mailing address:
  • Phone: 864-552-1142
  • Fax: 864-552-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number002535
License Number StateSC

VIII. Authorized Official

Name: BRENDA L CARRANO
Title or Position: OWNER
Credential:
Phone: 678-488-4889