Provider Demographics
NPI:1235323262
Name:EHLICH, DARTAGNON LANCE (DC)
Entity Type:Individual
Prefix:DR
First Name:DARTAGNON
Middle Name:LANCE
Last Name:EHLICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5895 CHESNEE HWY
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-8721
Mailing Address - Country:US
Mailing Address - Phone:864-461-2313
Mailing Address - Fax:864-461-2312
Practice Address - Street 1:5895 CHESNEE HWY
Practice Address - Street 2:
Practice Address - City:CHESNEE
Practice Address - State:SC
Practice Address - Zip Code:29323-8721
Practice Address - Country:US
Practice Address - Phone:864-461-2313
Practice Address - Fax:864-461-2312
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor