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General NPI Number Information
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NPI Number | 1124274618
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Entity Type | Organization
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Legal Business Name | SEA ISLE SPINE CENTER, INC
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 1137 JOHNNIE DODDS BLVD
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-3101
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Country | US
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Telephone | 843-881-2010
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Fax | 843-881-2009
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Provider Business Mailing Address
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Address Line | 1137 JOHNNIE DODDS BLVD
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-3101
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Country | US
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Telephone | 843-881-2010
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Fax | 843-881-2009
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. WILLIAM J CROMER
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Credential |
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Telephone | 843-881-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3296
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License Number State | SC
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