MEDICARE: EVERGREEN WELLNESS, 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	3675	SC

General Provider Information

NPI Number	:	1225315633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN WELLNESS, LLC

Provider Business Mailing Address
First Line	:	14 E BUTLER RD STE C
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2402
Country	:	US
Telephone Number	:	864-297-6270
Fax Number	:	864-509-9378

Provider Business Practice Location Address
First Line	:	14 E BUTLER RD STE C
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2402
Country	:	US
Telephone Number	:	864-297-6270
Fax Number	:	864-509-9378

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JERRY D NASHMAN
Credential	:	DC
Telephone Number	:	864-297-6270

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	12/30/2015

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Directions to “EVERGREEN WELLNESS, LLC ” Practice Location

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