Healthcare Provider Details

I. General information

NPI: 1093784266
Provider Name (Legal Business Name): CHARLES WAPNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 STATE ST
HOLLY HILL SC
29059-2611
US

IV. Provider business mailing address

PO BOX 1487
HOLLY HILL SC
29059-1487
US

V. Phone/Fax

Practice location:
  • Phone: 803-496-3338
  • Fax: 803-496-9229
Mailing address:
  • Phone: 803-496-3338
  • Fax: 803-496-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number803
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: