MEDICARE: CORRECTIVE CHIROPRACTIC FORT MILL

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	:	1730864489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRECTIVE CHIROPRACTIC FORT MILL

Provider Business Mailing Address
First Line	:	1826 HIGHWAY 160 W STE 103
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8254
Country	:	US
Telephone Number	:	839-600-3004
Fax Number	:	839-600-3004

Provider Business Practice Location Address
First Line	:	1826 HIGHWAY 160 W STE 103
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8254
Country	:	US
Telephone Number	:	839-600-3004
Fax Number	:	839-600-3004

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CARMEN GOGU
Credential	:	DC
Telephone Number	:	839-600-3004

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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