MEDICARE: ADVANCED CHIROPRACTIC CLINIC, P.A.

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	111NN0400X	Neurology Chiropractor	1361	SC

General Provider Information

NPI Number	:	1588731962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC CLINIC, P.A.

Provider Business Mailing Address
First Line	:	1808 SECOND BAXTER XING
Second Line	:	SUITE 108
City	:	FORT MILL
State	:	SC
Zip	:	29708-6436
Country	:	US
Telephone Number	:	803-802-2225
Fax Number	:	803-802-2275

Provider Business Practice Location Address
First Line	:	1808 SECOND BAXTER XING
Second Line	:	SUITE 108
City	:	FORT MILL
State	:	SC
Zip	:	29708-6436
Country	:	US
Telephone Number	:	803-802-2225
Fax Number	:	803-802-2275

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID PARKER THOMAS
Credential	:	D.C.
Telephone Number	:	803-802-2225

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/27/2007

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