Provider Demographics
NPI:1154462612
Name:SEA ONE FAMILY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:SEA ONE FAMILY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HERNDON
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-839-5262
Mailing Address - Street 1:1211 44TH AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5447
Mailing Address - Country:US
Mailing Address - Phone:843-839-5262
Mailing Address - Fax:
Practice Address - Street 1:1211 44TH AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5447
Practice Address - Country:US
Practice Address - Phone:843-839-5262
Practice Address - Fax:843-839-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty