Provider Demographics
NPI:1932330107
Name:WISE CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:WISE CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-585-5558
Mailing Address - Street 1:1400 FERNWOOD GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-3043
Mailing Address - Country:US
Mailing Address - Phone:864-585-5558
Mailing Address - Fax:864-585-9888
Practice Address - Street 1:1400 FERNWOOD GLENDALE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-3043
Practice Address - Country:US
Practice Address - Phone:864-585-5558
Practice Address - Fax:864-585-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2549111N00000X
SC3484111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2549Medicaid
SCU835050281Medicare UPIN