MEDICARE: ADVANCED CHIROPRACTIC CENTER P.C.

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	111NX0800X	Orthopedic Chiropractor	006632	GA

General Provider Information

NPI Number	:	1326463993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC CENTER P.C.

Provider Business Mailing Address
First Line	:	408 US HIGHWAY 80 SW
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-2541
Country	:	US
Telephone Number	:	912-748-0350
Fax Number	:	912-450-0350

Provider Business Practice Location Address
First Line	:	408 US HIGHWAY 80 SW
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-2541
Country	:	US
Telephone Number	:	912-748-0350
Fax Number	:	912-450-0350

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRESTON PEACOCK
Credential	:	DC
Telephone Number	:	912-748-0350

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	02/19/2014

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