Provider Demographics
NPI:1689676355
Name:MCKELVEY, MICHAEL SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:MCKELVEY
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 1:1264 RIBAUT RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6123
Mailing Address - Country:US
Mailing Address - Phone:843-524-4325
Mailing Address - Fax:843-524-2885
Practice Address - Street 1:1264 RIBAUT RD
Practice Address - Street 2:STE. 102
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6123
Practice Address - Country:US
Practice Address - Phone:843-524-4325
Practice Address - Fax:843-524-2885
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1890111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC350056792OtherMEDICARE RAILROAD
830345936OtherFEDERAL TAX ID NUMBER
830345936OtherFEDERAL TAX ID NUMBER
SCU62667Medicare UPIN