MEDICARE: LAND ASSOCIATES LLC

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	111NN1001X	Nutrition Chiropractor	002535	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	:	1881974756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAND ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2520 WADE HAMPTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1148
Country	:	US
Telephone Number	:	864-552-1142
Fax Number	:	864-552-1143

Provider Business Practice Location Address
First Line	:	2520 WADE HAMPTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1148
Country	:	US
Telephone Number	:	864-552-1142
Fax Number	:	864-552-1143

Authorized Official
Title or Position	:	OWNER
Name	:	BRENDA L CARRANO
Credential	:
Telephone Number	:	678-488-4889

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	10/04/2017

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Directions to “LAND ASSOCIATES LLC ” Practice Location

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