NPI | 1114248739 |
---|---|
Entity Type | Organization |
Authorized Contact | BRIAN QUATTLEBAUM Owner 843-552-8000 |
Organization Subpart ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: SC 3095) |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: SC 3095) |
Enumeration Date | 2010-06-17 |
Last Update Date | 2010-08-12 |