MEDICARE: SOUTH CAROLINA SPINE CARE, 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

General Provider Information

NPI Number	:	1790058626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CAROLINA SPINE CARE, LLC

Provider Business Mailing Address
First Line	:	217 FOREST BICKLEY RD
Second Line	:
City	:	CHAPIN
State	:	SC
Zip	:	29036-7122
Country	:	US
Telephone Number	:	803-429-7690
Fax Number	:	803-808-1297

Provider Business Practice Location Address
First Line	:	1926 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-8282
Country	:	US
Telephone Number	:	803-429-7690
Fax Number	:	803-808-1297

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	STEPHEN ANDREW STELLFOX
Credential	:	D.C.
Telephone Number	:	803-429-7690

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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