Provider Demographics
NPI:1689077489
Name:WISEMAN, ALLISUN ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLISUN
Middle Name:ANN
Last Name:WISEMAN
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 1:3200 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:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor