MEDICARE: PREMIER CHIROPRACTIC, 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

General Provider Information

NPI Number	:	1619290103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	2241 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9288
Country	:	US
Telephone Number	:	803-981-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2241 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9288
Country	:	US
Telephone Number	:	803-981-5100
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. CHARLES E HUSKINS
Credential	:
Telephone Number	:	803-981-5100

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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