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General NPI Number Information
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NPI Number | 1609088376
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Entity Type | Organization
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Legal Business Name | WILDEWOOD CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 130 PONTIAC BUSINESS CENTER DR SUITE A
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City | ELGIN
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State | SC
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Zip | 29045-9171
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Country | US
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Telephone | 803-865-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 130 PONTIAC BUSINESS CENTER DR SUITE A
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City | ELGIN
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State | SC
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Zip | 29045-9171
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Country | US
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Telephone | 803-865-2800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEE EPPERSON
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Credential | D.C.
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Telephone | 803-865-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2359
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License Number State | SC
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