MEDICARE: TRESNICKY CHIROPRACTIC LLC

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	3267	SC

General Provider Information

NPI Number	:	1245413228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRESNICKY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	5401 NETHERBY LN UNIT B2
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7363
Country	:	US
Telephone Number	:	843-767-0080
Fax Number	:	843-767-0030

Provider Business Practice Location Address
First Line	:	5401 NETHERBY LN STE 201
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7363
Country	:	US
Telephone Number	:	843-767-0080
Fax Number	:	843-767-0030

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL PAUL TRESNICKY
Credential	:	DC
Telephone Number	:	843-767-0080

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	04/01/2020

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