Provider Demographics
NPI:1063972255
Name:ENHANCED LIVING TRAVELERS REST
Entity type:Organization
Organization Name:ENHANCED LIVING TRAVELERS REST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-848-0640
Mailing Address - Street 1:148 WALNUT LN STE 1
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1600
Mailing Address - Country:US
Mailing Address - Phone:864-834-8099
Mailing Address - Fax:
Practice Address - Street 1:148 WALNUT LN STE 1
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1600
Practice Address - Country:US
Practice Address - Phone:864-834-8099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENHANCED LIVING CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty