Provider Demographics
NPI:1003109976
Name:LAYNE, TARA BISOGNA (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:BISOGNA
Last Name:LAYNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-1624
Mailing Address - Country:US
Mailing Address - Phone:803-271-4422
Mailing Address - Fax:
Practice Address - Street 1:2218 WILSON RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-1624
Practice Address - Country:US
Practice Address - Phone:803-233-6188
Practice Address - Fax:803-233-2831
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor