MEDICARE: TREE OF LIFE CHIROPRACTIC 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	3746	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750721700	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1841630878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF LIFE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 50621
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29250-0621
Country	:	US
Telephone Number	:	803-728-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 WILDEWOOD PARK DR
Second Line	:	SUITE B
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4301
Country	:	US
Telephone Number	:	803-728-6766
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. TREMAIN SINGLETON
Credential	:	DC
Telephone Number	:	803-728-6766

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	07/05/2013

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