Provider Demographics
NPI:1578634218
Name:WISE, MARYLOUISE SCHULTZ (DC)
Entity Type:Individual
Prefix:MRS
First Name:MARYLOUISE
Middle Name:SCHULTZ
Last Name:WISE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697
Mailing Address - Country:US
Mailing Address - Phone:864-847-6020
Mailing Address - Fax:864-847-6007
Practice Address - Street 1:24 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697
Practice Address - Country:US
Practice Address - Phone:864-847-6020
Practice Address - Fax:864-847-6007
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1594Medicaid
SCCH1594Medicaid