| NPI | 1790748150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON LLOYD ETHERIDGE President 843-875-2268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 1243) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 15987) |
| 225100000X Physical Therapist (Licence: SC 5123) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2023-03-07 |