Provider Demographics
NPI:1992211429
Name:KRU CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:KRU CHIROPRACTIC & WELLNESS
Other - Org Name:COASTLINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ULAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-999-1805
Mailing Address - Street 1:5187 HORRY DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5001 N KINGS HWY STE 204
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2556
Practice Address - Country:US
Practice Address - Phone:843-999-1805
Practice Address - Fax:855-277-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty