MEDICARE: MY CHIROPRACTOR 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	3285	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3285	OTHER	SC	DC LICENSE

General Provider Information

NPI Number	:	1639485071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY CHIROPRACTOR LLC

Provider Business Mailing Address
First Line	:	1454 GENTRY MEMORIAL HWY
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-6940
Country	:	US
Telephone Number	:	864-644-2700
Fax Number	:	864-644-2709

Provider Business Practice Location Address
First Line	:	16 WILLIAM POPE DR
Second Line	:	STE 103
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7502
Country	:	US
Telephone Number	:	843-505-6099
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH N BOGGS
Credential	:	DC
Telephone Number	:	864-574-8881

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	05/09/2015

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Directions to “MY CHIROPRACTOR LLC ” Practice Location

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