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General NPI Number Information
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NPI Number | 1275482416
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Entity Type | Organization
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Legal Business Name | KJ WELL, LLC
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 568 GEORGE BISHOP PKWY
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-7339
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Country | US
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Telephone | 843-455-2766
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 WOODLAWN DR
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City | CONWAY
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State | SC
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Zip | 29526-7703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE BOYLE
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Credential |
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Telephone | 843-455-2766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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