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General NPI Number Information
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NPI Number | 1245253269
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Entity Type | Individual
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Provider Name | LYLES GLENN HARDIN D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1645 J A COCHRAN BYPASS STE A ACCIDENT HEALTH CHIROPRACTIC
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City | CHESTER
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State | SC
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Zip | 29706-2105
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Country | US
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Telephone | 803-581-6446
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Fax | 803-581-5189
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Provider Business Mailing Address
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Address Line | 1645 J A COCHRAN BYPASS STE A ACCIDENT HEALTH CHIROPRACTIC
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City | CHESTER
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State | SC
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Zip | 29706-2105
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Country | US
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Telephone | 803-581-6446
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Fax | 803-581-5189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1157
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License Number State | SC
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