Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2453 | SC |
NPI | 1740203561 |
---|---|
Provider Name | Dr. John A Pienkos |
First Address | Conway, SC 29526-9136 |
Second Address | North Myrtle Beach, SC 29582-8943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 21/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH2453 | (05) | SC |
U83349 | (02) | SC |