Willis Chiro Med of MB

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2486 Issued in SC

Legal business name

WILLIS CHIRO MED OF MB

Doing business as

Willis Chiromed

Practice address

1665 Glenns Bay Rd
Surfside Beach, SC 29575-4836

Phone

(843) 215-2324

Fax

(843) 215-0541

NPI assigned

Dec 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles T Rogers Jr., D.C.

Title

President

Phone

(843) 215-2324

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• WILLIS CHIROMED Doing business as

Locations

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1649331000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1665 GLENNS BAY RD",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295754836",
            "telephone_number": "843-215-2324",
            "fax_number": "843-215-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 GLENNS BAY RD",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295754836",
            "telephone_number": "843-215-2324",
            "fax_number": "843-215-0541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS CHIRO MED OF MB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-215-2324",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "2486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2486",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLIS CHIROMED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathleen Wester, MS, CCC-SLP
• David B White, DMD
• William E Altman DDS PC
• Kimberly Williams, LDO
• Willis Chiro Med of MB
• Danielle Elizabeth Wirick
• David Lewis Wuischpard, RN
• Gretchen Mertz Yanez
• Eva C Yu, LAC

• Chiropractor in Surfside Beach, SC
• Providers in Surfside Beach, SC by specialty
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; 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.