MEDICARE: COLE CHIROPRACTIC CLINIC, 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	3204	SC

General Provider Information

NPI Number	:	1558535666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLE CHIROPRACTIC CLINIC, LLC

Provider Business Mailing Address
First Line	:	636 LONG POINT RD
Second Line	:	UNIT G #101
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8286
Country	:	US
Telephone Number	:	843-416-8593
Fax Number	:	855-738-7785

Provider Business Practice Location Address
First Line	:	3404 SALTERBECK ST
Second Line	:	# 201
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7119
Country	:	US
Telephone Number	:	843-416-8593
Fax Number	:	855-738-7785

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LUCAS J COLE
Credential	:	D.C.
Telephone Number	:	843-416-8593

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	07/21/2022

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