MEDICARE: DR. JOHN A PIENKOS CH

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	111NX0800X	Orthopedic Chiropractor	2453	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740203561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A PIENKOS CH

Provider Business Mailing Address
First Line	:	235 SINGLETON RIDGE RD
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-9136
Country	:	US
Telephone Number	:	843-357-1444
Fax Number	:	843-357-1471

Provider Business Practice Location Address
First Line	:	205 HWY 17 NORTH
Second Line	:	STE A
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-8943
Country	:	US
Telephone Number	:	843-280-7533
Fax Number	:	843-357-1471

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/21/2008

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Directions to “ DR. JOHN A PIENKOS CH” Practice Location

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