Organization
VIVATEK DISC REHAB CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL RAY COLE DC (OWNER)
(843) 249-5100
Entity
Organization
Contact information
Practice address
119 PINNACLE PL, SUITE B, LITTLE RIVER, SC 29566-7218
(843) 249-5100
Mailing address
119 PINNACLE PL, SUITE B, LITTLE RIVER, SC 29566-7218
(843) 249-5100
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1151
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CH1151
—
SC
01
—
T326948512
MEDICARE PTAN
SC
Enumeration date
06/29/2006
Last updated
04/10/2015
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