| 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 |