Provider Demographics
NPI:1649350356
Name:TROXELL, JIM A (DC)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:A
Last Name:TROXELL
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 1:802 13TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3816
Mailing Address - Country:US
Mailing Address - Phone:843-272-1717
Mailing Address - Fax:843-272-4338
Practice Address - Street 1:802 13TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3816
Practice Address - Country:US
Practice Address - Phone:843-272-1717
Practice Address - Fax:843-272-4338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC988111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT 250092809Medicare UPIN
SCT250092809Medicare PIN