MEDICARE: LADY AND LILLY ENTERPRIZES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2551	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619099470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADY AND LILLY ENTERPRIZES, INC.

Provider Business Mailing Address
First Line	:	8502 TWO NOTCH RD
Second Line	:	SUITE B
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6307
Country	:	US
Telephone Number	:	803-788-8254
Fax Number	:

Provider Business Practice Location Address
First Line	:	8502 TWO NOTCH RD
Second Line	:	SUITE B
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6307
Country	:	US
Telephone Number	:	803-788-8254
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	LEIF J HOAGLAND
Credential	:	DC
Telephone Number	:	803-788-8254

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	04/20/2008

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