Basic Information
| Provider Information | |||||||||
| NPI: | 1609103365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANTON CHIROPRACTIC AND WELLNESS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 WILLBROOK BLVD | ||||||||
| Address2: | SUITE N | ||||||||
| City: | PAWLEYS ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295856541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437500806 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 WILLBROOK BLVD | ||||||||
| Address2: | SUITE N | ||||||||
| City: | PAWLEYS ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295856541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437500806 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | STANTON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | KEMPER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8437500806 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 3490 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.