MEDICARE: MILLWOOD CHIROPRACTIC, INC.

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

General Provider Information

NPI Number	:	1316089402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLWOOD CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	1919 VETERANS BLVD
Second Line	:	SUITE 200
City	:	KENNER
State	:	LA
Zip	:	70062
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 MILLWOOD AVE
Second Line	:	SUITE A1
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1272
Country	:	US
Telephone Number	:	803-256-1213
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	BUFFIE L ROME
Credential	:
Telephone Number	:	504-467-0302

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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