Individual
SCOTT WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
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
01
—
1235436619
GROUP PRACTICE NPI
SC
05
—
285258
—
SC
01
—
5316
MEDICARE PTAN
SC
Enumeration date
02/17/2011
Last updated
03/21/2011
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