Organization
WALLACE CHIROPRACTIC AND SPINAL REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL KNIGHT (CA)
(843) 394-8274
Entity
Organization
Contact information
Practice address
263 KELLEY ST, SUITE 100, LAKE CITY, SC 29560-2472
(843) 394-8274
(843) 394-1604
Mailing address
263 KELLEY ST STE 100, LAKE CITY, SC 29560-2472
(843) 394-8274
(843) 394-1604
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1873
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GCH113
—
SC
Enumeration date
03/13/2008
Last updated
06/20/2013
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