MEDICARE: PARK CIRCLE CHIROPRACTIC CENTER 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	2062	SC

General Provider Information

NPI Number	:	1770599524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK CIRCLE CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	5122 N RHETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4240
Country	:	US
Telephone Number	:	843-744-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	5122 N RHETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4240
Country	:	US
Telephone Number	:	843-744-2265
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JAY MARTIN SCHWARTZ
Credential	:	D.C.
Telephone Number	:	843-744-2265

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/02/2007

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