Provider Demographics
NPI:1114321932
Name:WISEMAN FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WISEMAN FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-412-4232
Mailing Address - Street 1:3200 DEVINE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1891
Mailing Address - Country:US
Mailing Address - Phone:803-851-5450
Mailing Address - Fax:
Practice Address - Street 1:3200 DEVINE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1891
Practice Address - Country:US
Practice Address - Phone:803-851-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty