MEDICARE: WISE CHIROPRACTIC & REHABILITATION, LLC

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	3782	SC

General Provider Information

NPI Number	:	1457753881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE CHIROPRACTIC & REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	1400 FERNWOOD GLENDALE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-3043
Country	:	US
Telephone Number	:	864-585-5558
Fax Number	:	864-585-9888

Provider Business Practice Location Address
First Line	:	1400 FERNWOOD GLENDALE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-3043
Country	:	US
Telephone Number	:	864-585-5558
Fax Number	:	864-585-9888

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. HANNAH LANE
Credential	:	D.C.
Telephone Number	:	864-585-5558

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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