Provider Demographics
NPI:1720398886
Name:ADVANCED CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAUERSFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-648-0172
Mailing Address - Street 1:1028 RICHLAND AVE E
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4760
Mailing Address - Country:US
Mailing Address - Phone:803-648-0172
Mailing Address - Fax:803-648-5062
Practice Address - Street 1:1028 RICHLAND AVE E
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4760
Practice Address - Country:US
Practice Address - Phone:803-648-0172
Practice Address - Fax:803-648-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty