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General NPI Number Information
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NPI Number | 1285051631
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Entity Type | Organization
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Legal Business Name | BACK TO YOU CHIROPRACTIC
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 2315 WILLOW OAK DR
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City | COLUMBIA
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State | SC
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Zip | 29223-8608
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Country | US
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Telephone | 803-386-3912
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Fax | 803-403-8216
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | STATE PARK
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State | SC
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Zip | 29147-0055
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Country | US
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Telephone | 803-386-3912
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Fax | 803-403-8216
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. GAYLE N HEYER
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Credential | DC
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Telephone | 803-386-3912
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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 | 20144213741285
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License Number State | SC
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