Provider Demographics
NPI:1245253269
Name:HARDIN, LYLES GLENN (DC)
Entity type:Individual
Prefix:MR
First Name:LYLES
Middle Name:GLENN
Last Name:HARDIN
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 1:1645 J A COCHRAN BYPASS
Mailing Address - Street 2:STE A ACCIDENT HEALTH CHIROPRACTIC
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-2105
Mailing Address - Country:US
Mailing Address - Phone:803-581-6446
Mailing Address - Fax:803-581-5189
Practice Address - Street 1:1645 J A COCHRAN BYPASS
Practice Address - Street 2:STE A ACCIDENT HEALTH CHIROPRACTIC
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-2105
Practice Address - Country:US
Practice Address - Phone:803-581-6446
Practice Address - Fax:803-581-5189
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1157Medicaid
SCCH1157Medicaid