Healthcare Provider Details

I. General information

NPI: 1558558049
Provider Name (Legal Business Name): WISE HEALTH SOLUTIONS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 BROADWAY ST
MOUNT VERNON IL
62864-5115
US

IV. Provider business mailing address

329 BROADWAY ST
MOUNT VERNON IL
62864-5115
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-3370
  • Fax: 618-244-3395
Mailing address:
  • Phone: 618-244-3370
  • Fax: 618-244-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberH63975
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT LEE WISE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 618-244-3370