MEDICARE: DR JACK CHIROPRACTOR INC

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	261Q00000X	Clinic/Center	2259	SC

General Provider Information

NPI Number	:	1356836753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JACK CHIROPRACTOR INC

Provider Business Mailing Address
First Line	:	6335C CALHOUN MEMORIAL HWY STE C
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3784
Country	:	US
Telephone Number	:	864-859-8282
Fax Number	:	864-859-3628

Provider Business Practice Location Address
First Line	:	6335C CALHOUN MEMORIAL HWY STE C
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3784
Country	:	US
Telephone Number	:	864-859-8282
Fax Number	:	864-859-3628

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACK EDWARD NEWSOME JR.
Credential	:	DC
Telephone Number	:	864-607-0197

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/27/2018

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Directions to “DR JACK CHIROPRACTOR INC ” Practice Location

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