Healthcare Provider Details

I. General information

NPI: 1114586492
Provider Name (Legal Business Name): FAGAN CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E RUTHERFORD ST
LANDRUM SC
29356-1725
US

IV. Provider business mailing address

900 E RUTHERFORD ST
LANDRUM SC
29356-1725
US

V. Phone/Fax

Practice location:
  • Phone: 864-316-4611
  • Fax: 864-551-2945
Mailing address:
  • Phone: 864-316-4611
  • Fax: 864-551-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. LEALAND K FAGAN
Title or Position: OWNER
Credential: DC
Phone: 864-457-2045