Provider Demographics
NPI:1043523962
Name:BACK TO ESSENTIAL HEALTH AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:BACK TO ESSENTIAL HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:BACK TO ESSENTIALS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLSHONDA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:WAGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-206-8348
Mailing Address - Street 1:PO BOX 23885
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-3885
Mailing Address - Country:US
Mailing Address - Phone:803-708-9674
Mailing Address - Fax:803-708-8964
Practice Address - Street 1:1713 TAYLOR ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3400
Practice Address - Country:US
Practice Address - Phone:803-708-9674
Practice Address - Fax:803-708-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty