Organization
WILDEWOOD CHIROPRACTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEE EPPERSON D.C. (OWNER)
(803) 865-2800
Entity
Organization
Contact information
Practice address
130 PONTIAC BUSINESS CENTER DR, SUITE A, ELGIN, SC 29045-9171
(803) 865-2800
Mailing address
130 PONTIAC BUSINESS CENTER DR, SUITE A, ELGIN, SC 29045-9171
(803) 865-2800
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
2359
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2359
SC LICENSE NUMBER
SC
01
—
7279211
AETNA
SC
05
—
CH2359
—
SC
01
—
P00030172
RR MEDICARE
SC
Enumeration date
05/04/2007
Last updated
02/12/2009
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