| NPI | 1740727676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA REYES Operations 843-225-8414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4110) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: SC 4110) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2018-01-12 |