Provider Demographics
NPI:1083908370
Name:KAL, INC
Entity Type:Organization
Organization Name:KAL, INC
Other - Org Name:FITNESS FORUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUANICE
Authorized Official - Middle Name:MCBRIDE
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-661-3814
Mailing Address - Street 1:120 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-5522
Mailing Address - Country:US
Mailing Address - Phone:843-661-3814
Mailing Address - Fax:843-661-3851
Practice Address - Street 1:120 E ELM ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-5522
Practice Address - Country:US
Practice Address - Phone:843-661-3814
Practice Address - Fax:843-661-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103232083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty