Provider Demographics
NPI:1619099470
Name:LADY AND LILLY ENTERPRIZES, INC.
Entity Type:Organization
Organization Name:LADY AND LILLY ENTERPRIZES, INC.
Other - Org Name:RICHLAND CHIRORPACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-788-8254
Mailing Address - Street 1:8502 TWO NOTCH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6307
Mailing Address - Country:US
Mailing Address - Phone:803-788-8254
Mailing Address - Fax:
Practice Address - Street 1:8502 TWO NOTCH RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6307
Practice Address - Country:US
Practice Address - Phone:803-788-8254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2551Medicaid
SCCH2551Medicaid
SCU90168Medicare UPIN