MEDICARE: DR. EVAN SCOTT GRAINGER D.C.

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	3692	SC

General Provider Information

NPI Number	:	1275800740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN SCOTT GRAINGER D.C.

Provider Business Mailing Address
First Line	:	205 HIGHWAY 17 N
Second Line	:	SUITE A
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-8943
Country	:	US
Telephone Number	:	843-663-3377
Fax Number	:	843-280-2089

Provider Business Practice Location Address
First Line	:	205 HIGHWAY 17 N
Second Line	:	SUITE A
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-8943
Country	:	US
Telephone Number	:	843-663-3377
Fax Number	:	843-280-2089

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

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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