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General NPI Number Information
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NPI Number | 1962588798
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Entity Type | Organization
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Legal Business Name | NORTH MYRTLE BEACH CHIROPRACTIC PC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 513 HIGHWAY 17 N
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2903
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Country | US
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Telephone | 843-280-7000
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Fax | 843-280-7001
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Provider Business Mailing Address
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Address Line | 513 HIGHWAY 17 N
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2903
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Country | US
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Telephone | 843-280-7000
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Fax | 843-280-7001
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | KEVIN M. WALTER
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Credential | D.C.
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Telephone | 843-280-7000
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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 | 1652
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License Number State | SC
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