MEDICARE: DYNAMIC CHIROPRACTIC AND FUNCTIONAL MOVEMENT LLC

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	:	1508443060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC CHIROPRACTIC AND FUNCTIONAL MOVEMENT LLC

Provider Business Mailing Address
First Line	:	1314 LINCOLN ST STE 218
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3154
Country	:	US
Telephone Number	:	803-574-9344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 LINCOLN ST STE 218
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3154
Country	:	US
Telephone Number	:	803-574-9344
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	KATELYN SEABA
Credential	:	DC
Telephone Number	:	319-331-2006

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	01/19/2022

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