MEDICARE: CAROLINA FOREST 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	3616	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y36167	OTHER	MA	BC/BS OF MA
2	351103	OTHER	MA	HARVARD PILGRIM HEALTH
3	P-12032859	OTHER	MA	MULTIPLAN
4	Y39207	OTHER	MA	BLUE CROSS BLUE SHIELD MA
5	0222552-01	OTHER	MA	BMC HEALTHNET
6	B207689-01	OTHER	MA	CIGNA
7	001610	OTHER	MA	TUFTS HEALTH PLAN
8	42309	OTHER	MA	FALLON COMMUNITY HEALTH P
9	44-00274	OTHER	MA	UNITED HEALTH CARE
10	995969	OTHER	MA	NETWORK HEALTH
11	1003195	OTHER	MA	AMERICAN SPECIALTY HEALTH
12	04-3403673-00	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
13	646792	OTHER	MA	ACN GROUP
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	04-3403673	OTHER	MA	PRIVATE HEALTHCARE SYSTEM
16	2114793	OTHER	MA	AETNA
17	1496056	OTHER	MA	FIRST HEALTH

General Provider Information

NPI Number	:	1932207305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FOREST CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	4016 RIVER OAKS DR # 149
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6673
Country	:	US
Telephone Number	:	843-236-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	568 GEORGE BISHOP PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7339
Country	:	US
Telephone Number	:	843-236-2200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD J. PELLICANI
Credential	:	D.C.
Telephone Number	:	843-236-2200

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/26/2021

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