MEDICARE: MICHAEL S WEATHERFORD DC, P.A.

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	2567	SC

General Provider Information

NPI Number	:	1811304371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S WEATHERFORD DC, P.A.

Provider Business Mailing Address
First Line	:	1113 48TH AVE N
Second Line	:	SUITE 117
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5441
Country	:	US
Telephone Number	:	843-945-4717
Fax Number	:	843-945-4718

Provider Business Practice Location Address
First Line	:	1113 48TH AVE N
Second Line	:	SUITE 117
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5441
Country	:	US
Telephone Number	:	843-945-4717
Fax Number	:	843-945-4718

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL WEATHERFORD
Credential	:	D.C.
Telephone Number	:	843-945-4717

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/16/2014

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