MEDICARE: MRS. JIN LI DONG

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	1602	SC

General Provider Information

NPI Number	:	1518912286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JIN LI DONG

Provider Business Mailing Address
First Line	:	PO BOX 50727
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-0013
Country	:	US
Telephone Number	:	843-692-9243
Fax Number	:	843-692-9245

Provider Business Practice Location Address
First Line	:	4810 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2504
Country	:	US
Telephone Number	:	843-692-9243
Fax Number	:	843-692-9245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/12/2011

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