Provider Demographics
NPI:1689855157
Name:DR JIM A TROXELL PA
Entity Type:Organization
Organization Name:DR JIM A TROXELL PA
Other - Org Name:TROXELL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:TROXELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-272-1717
Mailing Address - Street 1:1415 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3803
Mailing Address - Country:US
Mailing Address - Phone:843-272-1717
Mailing Address - Fax:843-272-4338
Practice Address - Street 1:1415 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3803
Practice Address - Country:US
Practice Address - Phone:843-272-1717
Practice Address - Fax:843-272-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC988111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT250092809Medicare PIN
SC2809Medicare PIN