MEDICARE: ALLIED HLTH CTR OF N MYRTLE BEACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1438	SC
2	111N00000X	Chiropractor	2453	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053424119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED HLTH CTR OF N MYRTLE BEACH

Provider Business Mailing Address
First Line	:	235 SINGLETON RIDGE RD
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-9136
Country	:	US
Telephone Number	:	843-347-3444
Fax Number	:	843-347-1824

Provider Business Practice Location Address
First Line	:	205 HWY 17 NORTH
Second Line	:	STE A
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-8943
Country	:	US
Telephone Number	:	843-280-7533
Fax Number	:	843-357-1471

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN A PIENKOS II
Credential	:	D.C.
Telephone Number	:	843-347-3444

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/21/2008

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