Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1508 | SC |
N | 111NS0005X | Chiropractic Sports Physician | 1888 | NC |
NPI | 1154368124 |
---|---|
Provider Name | Antony M Rea |
First Address | Varnville, SC 29944 |
Second Address | Varnville, SC 29944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |