MEDICARE: CONVERSE 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	4135	SC

General Provider Information

NPI Number	:	1629429220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVERSE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	515 E SAINT JOHN ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1625
Country	:	US
Telephone Number	:	864-699-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 E SAINT JOHN ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1625
Country	:	US
Telephone Number	:	864-699-9990
Fax Number	:

Authorized Official
Title or Position	:	DR.
Name	:	CHRISTY RODY
Credential	:	D.C.
Telephone Number	:	405-401-9647

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	12/01/2019

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Directions to “CONVERSE CHIROPRACTIC ” Practice Location

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