MEDICARE: DR. VIRGINIA KAYE SAMUEL DC

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	111NI0900X	Internist Chiropractor	1561	SC
2	225X00000X	Occupational Therapist	3722	SC
3	111N00000X	Chiropractor	1561	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	:	1013931799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA KAYE SAMUEL DC

Provider Business Mailing Address
First Line	:	2757 LAUREL ST
Second Line	:	SUITE 4
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-252-4966
Fax Number	:	803-252-1984

Provider Business Practice Location Address
First Line	:	2757 LAUREL ST
Second Line	:	SUITE 4
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-252-4966
Fax Number	:	803-252-1984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/05/2020

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