Provider Demographics
NPI:1124274618
Name:SEA ISLE SPINE CENTER, INC
Entity type:Organization
Organization Name:SEA ISLE SPINE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-881-2010
Mailing Address - Street 1:1137 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3101
Mailing Address - Country:US
Mailing Address - Phone:843-881-2010
Mailing Address - Fax:843-881-2009
Practice Address - Street 1:1137 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3101
Practice Address - Country:US
Practice Address - Phone:843-881-2010
Practice Address - Fax:843-881-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1689881369OtherNPI TYPE 1