MEDICARE: KJ WELL, LLC

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1275482416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJ WELL, LLC

Provider Business Mailing Address
First Line	:	2021 WOODLAWN DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-7703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	568 GEORGE BISHOP PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7339
Country	:	US
Telephone Number	:	843-455-2766
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE BOYLE
Credential	:
Telephone Number	:	843-455-2766

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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