| Mychiroclub, P.a. | |
|
4012 Postal Way Ste A Myrtle Beach SC 29579-3298 | |
| (843) 236-6291 | |
| (843) 872-9190 |
| Full Name | Mychiroclub, P.a. |
|---|---|
| Speciality | Chiropractor |
| Location | 4012 Postal Way Ste A, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Neal Warren Lange (PRESIDENT) |
| Authorized Official Contact | 8432366291 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mychiroclub, P.a. 4012 Postal Way Suite A Myrtle Beach SC 29579-3537 Ph: (843) 236-6291 | Mychiroclub, P.a. 4012 Postal Way Ste A Myrtle Beach SC 29579-3298 Ph: (843) 236-6291 |
| NPI Number | 1063465045 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8628067956 |
|---|---|
| Medicare Enrollment ID | O20040511000615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063465045 | NPI | - | NPPES |
| 12137533 | Other | SC | MULTIPLAN |
| 2164911 | Other | SC | FIRST HEALTH |
| 2164911 | Other | SC | CCN |
| GCH435 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2874 (South Carolina) | Secondary |
| 111N00000X | Chiropractor | 2874 (South Carolina) | Primary |
| Provider Name | Neal Warren Lange |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1194797548 PECOS PAC ID: 4688663917 Enrollment ID: I20040511000650 |
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