Provider Demographics
NPI:1811304371
Name:MICHAEL S WEATHERFORD DC, P.A.
Entity type:Organization
Organization Name:MICHAEL S WEATHERFORD DC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-945-4717
Mailing Address - Street 1:1113 48TH AVE N
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5441
Mailing Address - Country:US
Mailing Address - Phone:843-945-4717
Mailing Address - Fax:843-945-4718
Practice Address - Street 1:1113 48TH AVE N
Practice Address - Street 2:SUITE 117
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5441
Practice Address - Country:US
Practice Address - Phone:843-945-4717
Practice Address - Fax:843-945-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty