Provider Demographics
NPI:1740203561
Name:PIENKOS, JOHN A (CH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:PIENKOS
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 SINGLETON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9136
Mailing Address - Country:US
Mailing Address - Phone:843-357-1444
Mailing Address - Fax:843-357-1471
Practice Address - Street 1:205 HWY 17 NORTH
Practice Address - Street 2:STE A
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-8943
Practice Address - Country:US
Practice Address - Phone:843-280-7533
Practice Address - Fax:843-357-1471
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2453111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2453Medicaid
SC8251Medicare PIN
SCCH2453Medicaid