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Tyrone D Wallace, DC
Chiropractor in Lake City, South Carolina
NPI 1780633420

Tyrone D Wallace is a Chiropractor based in Lake City, SC. Tyrone D Wallace practices in Lake City, SC and has the professional credentials of DC. The NPI Number for Tyrone D Wallace is 1780633420 and holds a License No. 1873 (South Carolina).

The current practice location address for Tyrone D Wallace is 263 Kelley St, Lake City, SC and can be reached out via phone at 843-394-8274 and via fax at 843-394-1604.

Location: 263 Kelley St, Lake City, SC, 29560-2450
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1780633420
Provider Name
Tyrone D Wallace
Credential
DC
Provider Entity Type
Individual
Gender
Male
Address
263 Kelley St, Lake City, SC, 29560-2450
Phone Number
843-394-8274
Fax Number
843-394-1604
Provider Enumeration Date
05/09/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
CH1873 05 SC
571012172 01 SC BC
institution
Provider Business Practice Location Address Details
Address
263 Kelley St
City
Lake City
State
South Carolina
Zip
29560-2450
Phone Number
843-394-8274
Fax Number
843-394-1604
person
Provider Business Mailing Address Details
Address
263 Kelley St
City
Lake City
State
South Carolina
Zip
29560-2450
Phone Number
843-394-8274
Fax Number
843-394-1604
person
Provider's Taxonomy Details 1
Type
Chiropractic Providers
Classification
Chiropractor
Speciality
-
Taxonomy
111N00000X
License No.
1873 (South Carolina)
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
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