Provider Demographics
NPI:1063852994
Name:ULAM, KATIE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:RENEE
Last Name:ULAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 N KINGS HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2556
Mailing Address - Country:US
Mailing Address - Phone:843-999-1805
Mailing Address - Fax:855-277-9141
Practice Address - Street 1:5001 N KINGS HWY STE 204
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2556
Practice Address - Country:US
Practice Address - Phone:843-999-1805
Practice Address - Fax:855-277-9141
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4432111N00000X
SC3832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor