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General NPI Number Information
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NPI Number | 1982829701
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Entity Type | Organization
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Legal Business Name | SOUTHERN CHIROPRACTIC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 221 COLUMBIA AVE
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City | LEXINGTON
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State | SC
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Zip | 29072-2611
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Country | US
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Telephone | 803-356-2870
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Fax | 803-356-2872
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Provider Business Mailing Address
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Address Line | 229 IVY HILL CT
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City | LEXINGTON
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State | SC
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Zip | 29072-8096
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Country | US
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Telephone | 803-269-2383
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALFREDO VALLEJO III
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Credential | D.C.
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Telephone | 803-269-2383
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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 | 2715
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License Number State | SC
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