MEDICARE: FOREST ACRES WELL CARE

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
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1821631706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST ACRES WELL CARE

Provider Business Mailing Address
First Line	:	5101 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-4962
Country	:	US
Telephone Number	:	803-318-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-4962
Country	:	US
Telephone Number	:	803-318-2811
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHELLE MCGILL
Credential	:	DC
Telephone Number	:	803-318-2811

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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Directions to “FOREST ACRES WELL CARE ” Practice Location

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