Provider Demographics
NPI:1093784266
Name:WAPNER, CHARLES
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WAPNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1487
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059-1487
Mailing Address - Country:US
Mailing Address - Phone:803-496-3338
Mailing Address - Fax:803-496-9229
Practice Address - Street 1:1120 STATE ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-2611
Practice Address - Country:US
Practice Address - Phone:803-496-3338
Practice Address - Fax:803-496-9229
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC803111N00000X
NC1241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CHO803 GCH182OtherMEDICAID PROVIDER
T236342211OtherPROVIDER NUMBER
SC2211Medicare PIN
SCT23634Medicare UPIN