=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902168503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWEIS FAMILY WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2012
-----------------------------------------------------
Last Update Date | 08/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1259 38TH AVE N
-----------------------------------------------------
City | MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29577-1313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-605-1600
-----------------------------------------------------
Fax | 843-872-0484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 50993
-----------------------------------------------------
City | MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29579-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-605-1600
-----------------------------------------------------
Fax | 843-872-0484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIAN L BROWN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 843-605-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------