Provider Demographics
NPI:1295861441
Name:AUDINO, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:AUDINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 SAINT THOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5436
Mailing Address - Country:US
Mailing Address - Phone:842-241-0200
Mailing Address - Fax:
Practice Address - Street 1:3738 WESLEY ST STE C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7402
Practice Address - Country:US
Practice Address - Phone:843-241-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU74583Medicare UPIN