Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3646 | SC |
NPI | 1003109976 |
---|---|
Provider Name | Dr. Tara Bisogna Layne |
First Address | Newberry, SC 29108-1624 |
Second Address | Newberry, SC 29108-1624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 18/05/2016 |