MEDICARE: SOUTH MAIN CHIROPRACTIC OF LEXINGTON, PLLC

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	261Q00000X	Clinic/Center	2779	NC

General Provider Information

NPI Number	:	1679678171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MAIN CHIROPRACTIC OF LEXINGTON, PLLC

Provider Business Mailing Address
First Line	:	813 S MAIN ST
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-3150
Country	:	US
Telephone Number	:	336-243-8000
Fax Number	:	336-243-8001

Provider Business Practice Location Address
First Line	:	813 S MAIN ST
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-3150
Country	:	US
Telephone Number	:	336-243-8000
Fax Number	:	336-243-8001

Authorized Official
Title or Position	:	MEMBER/ MANAGER
Name	:	DR. PHILIP A. MAHAN
Credential	:	DC
Telephone Number	:	336-243-8000

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	09/25/2012

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