# MYRTLE BEACH SPINE CENTER, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962764142
- **Authorized official:** DR. MICHAEL P GAMBACORTA DC, FNP-BC (OWNER)
- **Authorized official phone:** (843) 236-9090

## Contact information

- **Practice address:** 100 LEGENDS RD SUITE A, MYRTLE BEACH, SC 29579-7076
- **Practice address phone:** (843) 236-9090
- **Practice address fax:** (843) 236-9099
- **Mailing address:** 100 LEGENDS RD STE A, MYRTLE BEACH, SC 29579-7076
- **Mailing address phone:** (919) 394-3225
- **Mailing address fax:** (843) 236-9099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 2081N0008X | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081N0008X | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/13/2012
- **Last updated:** 09/05/2024