Provider Demographics
NPI:1447774922
Name:HEMINGWAY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:HEMINGWAY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEMINGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-250-3876
Mailing Address - Street 1:7212 HIGHWAY 908
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29546-5086
Mailing Address - Country:US
Mailing Address - Phone:843-250-3876
Mailing Address - Fax:
Practice Address - Street 1:1293 PROFESSIONAL DR STE 102
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5754
Practice Address - Country:US
Practice Address - Phone:843-250-3876
Practice Address - Fax:843-839-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3717Medicaid