MEDICARE: DMX IMAGING OF ANDERSON

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	111NR0400X	Rehabilitation Chiropractor	645	MI
2	174400000X	Specialist	645	MI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215158548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DMX IMAGING OF ANDERSON

Provider Business Mailing Address
First Line	:	3618 E RIVER ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-7334
Country	:	US
Telephone Number	:	864-224-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 E RIVER ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-7334
Country	:	US
Telephone Number	:	864-224-0283
Fax Number	:

Authorized Official
Title or Position	:	OWNER DC
Name	:	MR. GARY LEE WICKISER
Credential	:
Telephone Number	:	864-224-0283

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	09/11/2025

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