MEDICARE: PALMETTO CHIROPRACTIC CENTER 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	:	1376621664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO CHIROPRACTIC CENTER INC

Provider Business Mailing Address
First Line	:	929 N LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2137
Country	:	US
Telephone Number	:	803-356-8554
Fax Number	:	803-356-8245

Provider Business Practice Location Address
First Line	:	929 N LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2137
Country	:	US
Telephone Number	:	803-356-8554
Fax Number	:	803-356-8245

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. JASON ALLEN YODER
Credential	:	D.C.
Telephone Number	:	803-356-8554

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	04/23/2012

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