Healthcare Provider Details

I. General information

NPI: 1811304371
Provider Name (Legal Business Name): MICHAEL S WEATHERFORD DC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 48TH AVE N SUITE 117
MYRTLE BEACH SC
29577-5441
US

IV. Provider business mailing address

1113 48TH AVE N SUITE 117
MYRTLE BEACH SC
29577-5441
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-4717
  • Fax: 843-945-4718
Mailing address:
  • Phone: 843-945-4717
  • Fax: 843-945-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2567
License Number StateSC

VIII. Authorized Official

Name: MICHAEL WEATHERFORD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 843-945-4717