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General NPI Number Information
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NPI Number | 1457712168
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Entity Type | Organization
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Legal Business Name | NORTHWOOD CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 407 79TH AVE N
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-4310
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Country | US
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Telephone | 843-497-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 407 79TH AVE N
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-4310
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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 | CHIROPRACTOR
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Name | MR. ALBERT ASH JR.
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Credential | DC
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Telephone | 843-497-3691
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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 | 1039
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License Number State | SC
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