MEDICARE: DR. IVORY TORREY THIGPEN II D.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
1	111N00000X	Chiropractor	3053	SC

General Provider Information

NPI Number	:	1588698823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVORY TORREY THIGPEN II D.C.

Provider Business Mailing Address
First Line	:	126 RICE TERRACE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-9377
Country	:	US
Telephone Number	:	803-865-8738
Fax Number	:	803-256-1215

Provider Business Practice Location Address
First Line	:	2627 MILLWOOD AVE
Second Line	:	STE. A1
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1272
Country	:	US
Telephone Number	:	803-256-1213
Fax Number	:	803-256-1215

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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