Healthcare Provider Details

I. General information

NPI: 1154108991
Provider Name (Legal Business Name): ADVANCED WELLNESS SOLUTIONS OF THE UPSTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E CURTIS ST STE A
SIMPSONVILLE SC
29681-2620
US

IV. Provider business mailing address

19 KNOTTY PINE CT
FOUNTAIN INN SC
29644-9257
US

V. Phone/Fax

Practice location:
  • Phone: 864-641-3183
  • Fax:
Mailing address:
  • Phone: 864-283-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER DOYLE
Title or Position: CO-OWNER
Credential: DC
Phone: 864-283-2710