Provider Demographics
NPI:1245479641
Name:THOMAS, EDWARD SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:THOMAS
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 1:400 HIGHWAY 17 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6029
Mailing Address - Country:US
Mailing Address - Phone:843-238-5900
Mailing Address - Fax:843-238-5910
Practice Address - Street 1:400 HIGHWAY 17 N
Practice Address - Street 2:SUITE A
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6029
Practice Address - Country:US
Practice Address - Phone:843-238-5900
Practice Address - Fax:843-238-5910
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1245479641Medicare UPIN