NPIMap

Organization Active NPI

Waccamaw Family Chiropractic, P.C.

  • Chiropractor
  • Georgetown, SC
National Provider Identifier
1043617202
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3457 Issued in SC
Legal business name
WACCAMAW FAMILY CHIROPRACTIC, P.C.
Practice address
1153 N Fraser St
Georgetown, SC 29440-2851
Phone
(843) 545-7201
Fax
(843) 545-7202
NPI assigned
Dec 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew R Cullum, D.C.NPI 1588808794
Title
President
Phone
(803) 240-8766

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3457 SC Primary

Addresses

Primary practice location

1153 N Fraser St
Georgetown, SC 29440-2851

Mailing address

1153 N Fraser St
Georgetown, SC 29440-2851
Phone (843) 545-7201

Other names 1

  • Triune of Life Chiropractic, P.C. Former legal business name

National Provider Directory

National Provider Directory

Locations

1153 N Fraser St
Georgetown, SC 29440
Phone (843) 545-7201

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1043617202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1153 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402851",
            "telephone_number": "843-545-7201",
            "fax_number": "843-545-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1153 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402851",
            "telephone_number": "843-545-7201",
            "fax_number": "843-545-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACCAMAW FAMILY CHIROPRACTIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "CULLUM",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-240-8766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Triune of Life Chiropractic, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Georgetown, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.