MEDICARE: CAPITAL CITY CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1053655571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL CITY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1221 BOWER PKWY
Second Line	:	SUITE 108
City	:	COLUMBIA
State	:	SC
Zip	:	29212-3732
Country	:	US
Telephone Number	:	803-708-4258
Fax Number	:	803-708-4373

Provider Business Practice Location Address
First Line	:	1221 BOWER PKWY
Second Line	:	SUITE 108
City	:	COLUMBIA
State	:	SC
Zip	:	29212-3732
Country	:	US
Telephone Number	:	803-708-4258
Fax Number	:	803-708-4373

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARAH K LOSBY
Credential	:	DC
Telephone Number	:	803-708-4258

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	10/19/2015

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