Healthcare Provider Details

I. General information

NPI: 1790081875
Provider Name (Legal Business Name): DRAGONFLY WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 LATITUDE LN STE 103
CLOVER SC
29710-8129
US

IV. Provider business mailing address

264 LATITUDE LN STE 103
CLOVER SC
29710-8129
US

V. Phone/Fax

Practice location:
  • Phone: 803-746-5700
  • Fax:
Mailing address:
  • Phone: 803-746-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCIA LYNNE NIBERT
Title or Position: OWNER
Credential: D.C.
Phone: 803-746-5700