Healthcare Provider Details

I. General information

NPI: 1275482416
Provider Name (Legal Business Name): KJ WELL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 GEORGE BISHOP PKWY
MYRTLE BEACH SC
29579-7339
US

IV. Provider business mailing address

2021 WOODLAWN DR
CONWAY SC
29526-7703
US

V. Phone/Fax

Practice location:
  • Phone: 843-455-2766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE BOYLE
Title or Position: OWNER
Credential:
Phone: 843-455-2766