MEDICARE: SPIRITUS 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	:	1629768999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRITUS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	215 SOCIETY ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-5637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 SOCIETY ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-5637
Country	:	US
Telephone Number	:	864-556-3240
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN COOK
Credential	:	DC
Telephone Number	:	864-556-3240

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	05/10/2023

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