Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2119 | SC |
NPI | 1013025931 |
---|---|
Provider Name | Dr. Zachary Grant Causey |
First Address | Myrtle Beach, SC 29588-0015 |
Second Address | Myrtle Beach, SC 29579-3587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 29/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH2119 | (05) | SC |
U64205 | (02) |