MEDICARE: CLIFTON WAYNE WICKISER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2599	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144309469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON WAYNE WICKISER D.C.

Provider Business Mailing Address
First Line	:	3618 E RIVER ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-7334
Country	:	US
Telephone Number	:	864-224-0246
Fax Number	:	864-224-2524

Provider Business Practice Location Address
First Line	:	3618 E RIVER ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-7334
Country	:	US
Telephone Number	:	864-224-0246
Fax Number	:	864-224-2524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	06/15/2015

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