Provider Demographics
NPI:1215162136
Name:WACCAMAW FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:WACCAMAW FAMILY CHIROPRACTIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:CULLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-240-8766
Mailing Address - Street 1:11945 GRANDHAVEN DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8091
Mailing Address - Country:US
Mailing Address - Phone:843-357-7200
Mailing Address - Fax:843-357-7203
Practice Address - Street 1:11945 GRANDHAVEN DR
Practice Address - Street 2:SUITE F
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8091
Practice Address - Country:US
Practice Address - Phone:843-357-7200
Practice Address - Fax:843-357-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty