Provider Demographics
NPI:1063583631
Name:WINYAH CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:WINYAH CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BYRNES
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-546-3020
Mailing Address - Street 1:2504 HIGHMARKET ST
Mailing Address - Street 2:PO DRAWER 1717
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2910
Mailing Address - Country:US
Mailing Address - Phone:843-546-3020
Mailing Address - Fax:843-527-1816
Practice Address - Street 1:2504 HIGHMARKET ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29442-1717
Practice Address - Country:US
Practice Address - Phone:843-546-3020
Practice Address - Fax:843-527-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 0641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1881655249OtherTYPE 1 NPI NUMBER
SCT23959Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER
SC1881655249OtherTYPE 1 NPI NUMBER