Provider Demographics
NPI:1053424119
Name:ALLIED HLTH CTR OF N MYRTLE BEACH
Entity type:Organization
Organization Name:ALLIED HLTH CTR OF N MYRTLE BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIENKOS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:843-347-3444
Mailing Address - Street 1:235 SINGLETON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9136
Mailing Address - Country:US
Mailing Address - Phone:843-347-3444
Mailing Address - Fax:843-347-1824
Practice Address - Street 1:205 HWY 17 NORTH
Practice Address - Street 2:STE A
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-8943
Practice Address - Country:US
Practice Address - Phone:843-280-7533
Practice Address - Fax:843-357-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2453111N00000X
SC1438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH504Medicaid
SCGP4338Medicaid
SC8251Medicare PIN