Provider Demographics
NPI:1467419721
Name:CHILTON, RUBERT GARLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:RUBERT
Middle Name:GARLAND
Last Name:CHILTON
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 1:607 19TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3103
Mailing Address - Country:US
Mailing Address - Phone:843-946-6325
Mailing Address - Fax:843-626-6776
Practice Address - Street 1:607 19TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3103
Practice Address - Country:US
Practice Address - Phone:843-946-6325
Practice Address - Fax:843-626-6776
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2467Medicaid
SCCH2467Medicaid