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NPI Code Detail

MEDICARE: SOUTHEASTERN CHIROPRACTIC CENTER P C

MEDICARE: SOUTHEASTERN CHIROPRACTIC CENTER P C
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
1111NS0005XSports Physician Chiropractor1581SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11578629861OTHERSCNPI INDIVIDUAL

General Provider Information

NPI Number : 1588073233
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN CHIROPRACTIC CENTER P C
Provider Business Mailing Address
First Line : PO BOX 11596
Second Line :
City : COLUMBIA
State : SC
Zip : 29211-1596
Country : US
Telephone Number : 803-553-3368
Fax Number :
Provider Business Practice Location Address
First Line : 6420 GARNERS FERRY RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1632
Country : US
Telephone Number : 803-553-3368
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LEWIS RANDAL HINSON
Credential : DC, CCSP
Telephone Number : 803-553-3368
Provider Enumeration Date : 08/07/2014
Last Update Date : 10/15/2014

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Directions to “SOUTHEASTERN CHIROPRACTIC CENTER P C ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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