1. Home
  2. Directory
  3. South Carolina
  4. Lake City
  5. Chiropractor
  6. NPI Profile

TYRONE D WALLACE DC
NPI 1780633420
Chiropractor in Lake City, SC

Active since May 09, 2006
263 KELLEY ST, STE 100, LAKE CITY, SC 29560(843) 394-8274(843) 394-1604 Get Directions Write a Review

NPPES record last updated: December 7, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Tyrone D Wallace Dc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYRONE D WALLACE DC (NPI 1780633420) is an individual chiropractor in Lake City, South Carolina, licensed in South Carolina (1873) and active in the NPI registry since May 2006. He is a graduate of Sherman College Of Straight Chiropractic (1994).

NPPES Registry Identity

NPI1780633420
Entity TypeIndividualMale
Primary Taxonomy111N00000X
Provider Legal NameTYRONE D WALLACECredential: DC
Location Address263 KELLEY ST, STE 100Lake City, SC 29560-2450
Mailing Address263 Kelley St, Ste 100Lake City, SC 29560-2450 · (843) 394-8274 · Fax (843) 394-1604
Phone(843) 394-8274
Fax(843) 394-1604
Sole ProprietorYes
Medical School CMSSherman College Of Straight ChiropracticGraduated 1994
Enumeration DateMay 9, 2006
Last NPPES UpdateDecember 7, 2016
✔ NPI 1780633420 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
License✔ Licensed in SC · 1873
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
263 KELLEY ST, Lake City, SC 29560
Open in Google Maps ↗

Other Identifiers 5

Medicare UPINU53372SC
MedicaidCH1873SC
Other571012172SC · Bc
Medicare NSC6481000001SC
Medicare PINU533720281SC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, First Choice Next, Molina Healthcare and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tyrone D Wallace Dc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1557541224
PECOS Enrollment IDI20110404000657

Medicare Billing Reassignment

Medicare enrollment records show Tyrone Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Prime Care Of The Lower Pee Dee, LLC
Same address
Multi-Specialty
263 KELLEY ST STE 100
Lake City, SC 29560
  • Reassigned Medicare billing, South Carolina enrollment
NPI 1437692407 (843) 394-8274

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Chiropractic manipulative treatment, 1-2 spinal regions 98940
Chiropractic manipulative treatment focuses on adjusting your spine to improve your body's physical function. In this service, a chiropractor applies controlled force to 1-2 spinal regions. This helps to restore mobility and alleviate discomfort in those areas.
277 services15 patients

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WALLACE CHIROPRACTIC AND SPINAL REHAB, LLC
Chiropractor
263 KELLEY ST, SUITE 100
LAKE CITY, SC 29560
Florence County (843) 394-8274
PRIMECARE OF THE LOWER PEE DEE LLC
Chiropractor
263 KELLEY ST, STE 100
LAKE CITY, SC 29560
Florence County (843) 394-8274

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tyrone Wallace's NPI number?

The NPI number for Tyrone Wallace is 1780633420. It was assigned to this individual provider in the NPPES registry on May 9, 2006.

Where is Tyrone Wallace located?

Tyrone Wallace practices at 263 Kelley St Ste 100, Lake City, SC 29560. The listed phone number is (843) 394-8274.

What is Tyrone Wallace's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Tyrone Wallace enrolled in Medicare?

Yes. Tyrone Wallace is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Tyrone Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tyrone Wallace reassigns Medicare benefits to Prime Care Of The Lower Pee Dee, LLC (Lake City, SC). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tyrone Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Tyrone Wallace accept?

Health plans from Ambetter Health, First Choice Next, Molina Healthcare and UnitedHealthcare list Tyrone Wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tyrone Wallace was last updated on December 7, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.