Healthcare Provider Details

I. General information

NPI: 1295713519
Provider Name (Legal Business Name): PC MARTIN CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HWY 17 N
SURFSIDE BEACH SC
29575-6029
US

IV. Provider business mailing address

400 HWY 17 N
SURFSIDE BEACH SC
29575-6029
US

V. Phone/Fax

Practice location:
  • Phone: 843-238-5900
  • Fax: 843-238-5910
Mailing address:
  • Phone: 843-238-5900
  • Fax: 843-238-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2851
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2253
License Number StateSC

VIII. Authorized Official

Name: DR. CAROLE A MARTIN
Title or Position: OWNER
Credential: DC
Phone: 843-238-5900