Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3905 | SC |
N | 111N00000X | Chiropractor | DC3905 | SC |
NPI | 1003235854 |
---|---|
Provider Name | Dr. Theresa Lobbestael |
First Address | Fort Mill, SC 29708-6533 |
Second Address | Fort Mill, SC 29708-6533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 26/04/2018 |