Healthcare Provider Details

I. General information

NPI: 1063465045
Provider Name (Legal Business Name): MYCHIROMED, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 POSTAL WAY STE A
MYRTLE BEACH SC
29579-3298
US

IV. Provider business mailing address

4012 POSTAL WAY STE A
MYRTLE BEACH SC
29579-3298
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-6291
  • Fax: 843-872-9190
Mailing address:
  • Phone: 843-236-4400
  • Fax: 843-481-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2874
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2874
License Number StateSC

VIII. Authorized Official

Name: NEAL WARREN LANGE JR.
Title or Position: PRESIDENT
Credential: DC
Phone: 843-236-4400