MEDICARE: THE BODY 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	3625	SC

General Provider Information

NPI Number	:	1548629397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BODY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7671 NORTHWOODS BLVD
Second Line	:	STE. G
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-4058
Country	:	US
Telephone Number	:	843-820-5313
Fax Number	:	843-228-9024

Provider Business Practice Location Address
First Line	:	7671 NORTHWOODS BLVD
Second Line	:	STE. G
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-4058
Country	:	US
Telephone Number	:	843-820-5313
Fax Number	:	843-228-9024

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	BRIAN COOKE
Credential	:
Telephone Number	:	843-501-3851

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	08/31/2016

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Directions to “THE BODY CHIROPRACTIC ” Practice Location

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