Healthcare Provider Details

I. General information

NPI: 1366567778
Provider Name (Legal Business Name): ACCIDENT INJURY AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W PALMETTO ST
FLORENCE SC
29501-4427
US

IV. Provider business mailing address

507 W PALMETTO ST
FLORENCE SC
29501-4427
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-1010
  • Fax: 843-669-1054
Mailing address:
  • Phone: 843-669-1010
  • Fax: 843-669-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2474
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3406
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11313
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6253900001
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1091
License Number StateSC
# 6
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number11313
License Number StateSC

VIII. Authorized Official

Name: MRS. JENNIFER MCKAY
Title or Position: OFFICE MANGER
Credential:
Phone: 843-669-1010