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General NPI Number Information
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NPI Number | 1932207305
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Entity Type | Organization
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Legal Business Name | CAROLINA FOREST CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/26/2021
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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 | 843-236-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 4016 RIVER OAKS DR # 149
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-6673
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Country | US
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Telephone | 843-236-2200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD J. PELLICANI
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Credential | D.C.
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Telephone | 843-236-2200
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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 | 3616
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License Number State | SC
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