Provider Demographics
NPI:1275677841
Name:EPPERSON, LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:EPPERSON
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 1:130 PONTIAC BUSINESS CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-9171
Mailing Address - Country:US
Mailing Address - Phone:803-865-2800
Mailing Address - Fax:
Practice Address - Street 1:130 PONTIAC BUSINESS CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-9171
Practice Address - Country:US
Practice Address - Phone:803-865-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2359OtherSC LICENSE NUMBER
SCP00030172OtherRR MEDICARE
SC7279211OtherAETNA - EPDB PIN
SCCH2359Medicaid
SC7279211OtherAETNA - EPDB PIN
SC7279211OtherAETNA - EPDB PIN