Healthcare Provider Details

I. General information

NPI: 1669387395
Provider Name (Legal Business Name): SALT WATER CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 SC 90 EAST UNIT C /FIRE FOX PLAZA
LITTLE RIVER SC
29566
US

IV. Provider business mailing address

3201 BELLS LAKE CIR
LONGS SC
29568-7653
US

V. Phone/Fax

Practice location:
  • Phone: 843-864-4096
  • Fax:
Mailing address:
  • Phone: 843-864-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: LESLEY A WALKER
Title or Position: SOLE MEMBER
Credential: DC
Phone: 843-864-4096