Healthcare Provider Details

I. General information

NPI: 1134202427
Provider Name (Legal Business Name): WELLFORD CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GROCE RD
LYMAN SC
29365-1631
US

IV. Provider business mailing address

12 GROCE RD
LYMAN SC
29365-1631
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-1345
  • Fax:
Mailing address:
  • Phone: 864-439-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1365
License Number StateSC

VIII. Authorized Official

Name: DR. HENRY E. BRUCE
Title or Position: OWNER
Credential: DC
Phone: 864-439-1345