MEDICARE: SAMUEL CHIROPRACTIC PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407935596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	2757 LAUREL ST
Second Line	:	SUITE 4
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-252-4966
Fax Number	:	803-252-1984

Provider Business Practice Location Address
First Line	:	2757 LAUREL ST
Second Line	:	SUITE 4
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-252-4966
Fax Number	:	803-252-1984

Authorized Official
Title or Position	:	CHIROPRACTOR, OT
Name	:	DR. VIRGINIA K SAMUEL
Credential	:	DC,CCEP,DABCI,BS,MS,
Telephone Number	:	803-252-4966

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/05/2020

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