MEDICARE: HEMINGWAY FAMILY CHIROPRACTIC

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	3717	SC

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	:	1447774922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEMINGWAY FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7212 HIGHWAY 908
Second Line	:
City	:	GRESHAM
State	:	SC
Zip	:	29546-5086
Country	:	US
Telephone Number	:	843-250-3876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1293 PROFESSIONAL DR STE 102
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5754
Country	:	US
Telephone Number	:	843-250-3876
Fax Number	:	843-839-9831

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. JENICA D HEMINGWAY
Credential	:	DC
Telephone Number	:	843-250-3876

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	07/27/2017

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