Healthcare Provider Details

I. General information

NPI: 1225061328
Provider Name (Legal Business Name): THE WELLNESS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11068 ASHEVILLE HWY STE. B-17
INMAN SC
29349-5805
US

IV. Provider business mailing address

68 GLOBAL DR SUITE 100
GREENVILLE SC
29607-4628
US

V. Phone/Fax

Practice location:
  • Phone: 864-473-1083
  • Fax:
Mailing address:
  • Phone: 864-644-2700
  • Fax: 864-644-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2231
License Number StateSC

VIII. Authorized Official

Name: TYLER R MASON
Title or Position: OWNER
Credential:
Phone: 864-473-1083