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General NPI Number Information
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NPI Number | 1619099470
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Entity Type | Organization
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Legal Business Name | LADY AND LILLY ENTERPRIZES, INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 8502 TWO NOTCH RD SUITE B
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City | COLUMBIA
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State | SC
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Zip | 29223-6307
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Country | US
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Telephone | 803-788-8254
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Fax |
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Provider Business Mailing Address
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Address Line | 8502 TWO NOTCH RD SUITE B
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City | COLUMBIA
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State | SC
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Zip | 29223-6307
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Country | US
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Telephone | 803-788-8254
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | LEIF J HOAGLAND
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Credential | DC
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Telephone | 803-788-8254
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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 | 2551
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License Number State | SC
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