Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4238 | SC |
N | 111NP0017X | Pediatric Chiropractor | 4238 | SC |
NPI | 1902334345 |
---|---|
Provider Name | Dr. Tyler Lee Maxey |
First Address | Boiling Springs, SC 29316-6624 |
Second Address | Boiling Springs, SC 29316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2017 |
Last Update Date | 01/02/2019 |