Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3710 | SC |
NPI | 1003108093 |
---|---|
Provider Name | Kimberly Brooke Wheaton |
First Address | Charleston, SC 29407-7187 |
Second Address | Charleston, SC 29407-7187 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2011 |
Last Update Date | 23/02/2012 |