Provider Demographics
NPI:1467521971
Name:O NEILL, TIMOTHY B (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:O NEILL
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 1:3975 DICK POND RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6800
Mailing Address - Country:US
Mailing Address - Phone:843-650-3232
Mailing Address - Fax:843-650-9877
Practice Address - Street 1:3975 DICK POND RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6800
Practice Address - Country:US
Practice Address - Phone:843-650-3232
Practice Address - Fax:843-650-9877
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1029111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT23678Medicare UPIN
SCT236780281Medicare PIN