MEDICARE: DR. RACHEL KATHRYN WURDEMANN DC

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	4372	SC

General Provider Information

NPI Number	:	1427512409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL KATHRYN WURDEMANN DC

Provider Business Mailing Address
First Line	:	130 RIVER LANDING DR UNIT 11102
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7427
Country	:	US
Telephone Number	:	651-724-7094
Fax Number	:

Provider Business Practice Location Address
First Line	:	194 SEVEN FARMS DR UNIT 600D
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-8509
Country	:	US
Telephone Number	:	843-751-2234
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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