MEDICARE: DR. AMBER MARIE PEDERSON D.C.

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	4011	SC

General Provider Information

NPI Number	:	1932599693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER MARIE PEDERSON D.C.

Provider Business Mailing Address
First Line	:	244 LATITUDE LN
Second Line	:	UNIT 104
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8124
Country	:	US
Telephone Number	:	803-831-6500
Fax Number	:	803-831-6383

Provider Business Practice Location Address
First Line	:	244 LATITUDE LN
Second Line	:	UNIT 104
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8124
Country	:	US
Telephone Number	:	803-831-6500
Fax Number	:	803-831-6383

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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