NPIMap

Organization Active NPI

Willis Chiro Med-MB, Inc.

  • Chiropractor
  • Myrtle Beach, SC
National Provider Identifier
1235436619
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
997 Issued in SC
Legal business name
WILLIS CHIRO MED-MB, INC.
Practice address
2105 Cromley Cir Ste B
Myrtle Beach, SC 29577-3168
Phone
(843) 626-6666
Fax
(888) 456-9396
NPI assigned
Feb 20, 2011
Organization subpart
Yes
Parent organization
WILLIS CHIRO MED-MB, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

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

Authorized official

Name
Scott Willis, D.C.NPI 1982901567
Title
Owner
Phone
(843) 626-6666

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 997 SC Primary

Addresses

Primary practice location

2105 Cromley Cir Ste B
Myrtle Beach, SC 29577-3168

Mailing address

2105 Cromley Cir Ste B
Myrtle Beach, SC 29577-3168
Phone (843) 626-6666

Other identifiers 2

IdentifierTypeStateIssuer
5316OtherSCMEDICARE PTAN
285285MedicaidSC

Other names 1

  • WILLIS CHIRO MED-MB, INC. Doing business as

National Provider Directory

National Provider Directory
Part of
Willis Chiro Med of MB

Locations

2105 Cromley Cir
Ste B
Myrtle Beach, SC 29577
Phone (843) 626-6666

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1298160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1235436619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 CROMLEY CIR STE B",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295773168",
            "telephone_number": "843-626-6666",
            "fax_number": "888-456-9396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 CROMLEY CIR STE B",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295773168",
            "telephone_number": "843-626-6666",
            "fax_number": "888-456-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS CHIRO MED-MB, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIS CHIRO MED-MB, INC.",
        "enumeration_date": "2011-02-20",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-626-6666",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "5316",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285285",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLIS CHIRO MED-MB, INC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.