MEDICARE: LSE 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	2726	SC

General Provider Information

NPI Number	:	1083058333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	149 E BAY ST
Second Line	:	SUITE 100
City	:	CHARLESTON
State	:	SC
Zip	:	29401-2163
Country	:	US
Telephone Number	:	843-853-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1254 YEAMANS HALL RD
Second Line	:
City	:	HANAHAN
State	:	SC
Zip	:	29410-2787
Country	:	US
Telephone Number	:	843-554-8312
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	STEPHEN KHOURI
Credential	:	D.C
Telephone Number	:	843-853-2225

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	04/30/2013

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Directions to “LSE CHIROPRACTIC ” Practice Location

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