MEDICARE: FOWLER CHIROPRACTIC

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	1191	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285907659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOWLER CHIROPRACTIC

Provider Business Mailing Address
First Line	:	111 N MATTHEWS RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2309
Country	:	US
Telephone Number	:	843-374-8299
Fax Number	:	843-374-2195

Provider Business Practice Location Address
First Line	:	111 N MATTHEWS RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2309
Country	:	US
Telephone Number	:	843-374-8299
Fax Number	:	843-374-2195

Authorized Official
Title or Position	:	DOCTOR
Name	:	TERRELL E FOWLER III
Credential	:	D.C
Telephone Number	:	843-374-8299

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	02/16/2012

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Directions to “FOWLER CHIROPRACTIC ” Practice Location

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