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Organization
WILLIS CHIRO MED-MB, INC.
Active
Organization
WILLIS CHIRO MED-MB, INC.
Active
Parent organization
WILLIS CHIRO MED-MB, INC.
Other names
WILLIS CHIRO MED-MB, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILLIS CHIRO MED-MB, INC.
Authorized official
SCOTT WILLIS D.C. (OWNER)
(843) 626-6666
Entity
Organization
Contact information
Practice address
2105 CROMLEY CIR STE B, MYRTLE BEACH, SC 29577-3168
(843) 626-6666
(888) 456-9396
Mailing address
2105 CROMLEY CIR STE B, MYRTLE BEACH, SC 29577-3168
(843) 626-6666
(888) 456-9396
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
997
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285285
—
SC
01
—
5316
MEDICARE PTAN
SC
Enumeration date
02/20/2011
Last updated
03/21/2011
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