MEDICARE: DR. DAVID G REDDING 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	X007233	NY
2	111N00000X	Chiropractor	3169	NC
3	111N00000X	Chiropractor	4080	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18-1837267	OTHER	SC	BLUE CROSS BLUE SHIELD
2	P010007233	OTHER	NY	BLUE CHOICE PROV ID
3	P020007233	OTHER	NY	BLUECROSS BLUE SHIELD

General Provider Information

NPI Number	:	1477538551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID G REDDING DC

Provider Business Mailing Address
First Line	:	4543 CHARLOTTE HWY STE 9
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-7057
Country	:	US
Telephone Number	:	803-701-7077
Fax Number	:	803-620-4812

Provider Business Practice Location Address
First Line	:	4543 CHARLOTTE HWY STE 9
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-7057
Country	:	US
Telephone Number	:	803-701-7077
Fax Number	:	803-620-4812

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	04/04/2018

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Directions to “ DR. DAVID G REDDING DC” Practice Location

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