MEDICARE: MICHAEL SCOTT MCKELVEY D.C.

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	111NS0005X	Sports Physician Chiropractor	1890	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350056792	OTHER	SC	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1689676355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SCOTT MCKELVEY D.C.

Provider Business Mailing Address
First Line	:	1264 RIBAUT RD
Second Line	:	STE. 102
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6123
Country	:	US
Telephone Number	:	843-524-4325
Fax Number	:	843-524-2885

Provider Business Practice Location Address
First Line	:	1264 RIBAUT RD
Second Line	:	STE. 102
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6123
Country	:	US
Telephone Number	:	843-524-4325
Fax Number	:	843-524-2885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/03/2008

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