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General NPI Number Information
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NPI Number | 1821177080
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Entity Type | Organization
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Legal Business Name | ATLANTIC SPINE,LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1105 48TH AVE N STE 106
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5419
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Country | US
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Telephone | 843-497-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 48TH AVE N STE 106
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5419
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Country | US
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Telephone | 843-497-5197
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JOHN P GRANT
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Credential | D.C.
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Telephone | 843-497-5197
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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 | 2736
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License Number State | SC
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