Healthcare Provider Details

I. General information

NPI: 1518593334
Provider Name (Legal Business Name): WALTON FAMILY CHIROPRACTIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WARLEY ST STE A
FLORENCE SC
29501-4443
US

IV. Provider business mailing address

126 WARLEY ST STE A
FLORENCE SC
29501-4443
US

V. Phone/Fax

Practice location:
  • Phone: 843-508-8181
  • Fax: 806-626-1474
Mailing address:
  • Phone: 843-508-8181
  • Fax: 806-626-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA JO WALTON
Title or Position: OWNER, CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 843-508-8181