Provider Demographics
NPI:1417183955
Name:PALMS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PALMS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-260-0183
Mailing Address - Street 1:220 RONNIE COURT
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579
Mailing Address - Country:US
Mailing Address - Phone:843-903-5522
Mailing Address - Fax:843-903-5523
Practice Address - Street 1:220 RONNIE COURT
Practice Address - Street 2:SUITE 3
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-903-5522
Practice Address - Fax:843-903-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty