MEDICARE: CLOVER 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	842	SC

General Provider Information

NPI Number	:	1265854269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVER CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	225 CHURCH ST
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-1008
Country	:	US
Telephone Number	:	803-222-2323
Fax Number	:	803-222-2323

Provider Business Practice Location Address
First Line	:	225 CHURCH ST
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-1008
Country	:	US
Telephone Number	:	803-222-2323
Fax Number	:	803-222-2323

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT W BRODNAX
Credential	:	D.C.
Telephone Number	:	803-222-2323

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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Directions to “CLOVER CHIROPRACTIC LLC ” Practice Location

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