MEDICARE: DR. MARCIA LYNNE NIBERT D.C., LAC

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	1689	SC
2	171100000X	Acupuncturist	49	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U457480281	OTHER	SC	MEDICARE ID

General Provider Information

NPI Number	:	1871596049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCIA LYNNE NIBERT D.C., LAC

Provider Business Mailing Address
First Line	:	264 LATITUDE LN STE 103
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-8129
Country	:	US
Telephone Number	:	803-746-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 LATITUDE LN STE 103
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-8129
Country	:	US
Telephone Number	:	803-746-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/26/2020

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