Healthcare Provider Details

I. General information

NPI: 1245301985
Provider Name (Legal Business Name): COMPLETE HEALING & WELLNESS CENTER P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 EAST MAIN ST
WILLIAMSTON SC
29697
US

IV. Provider business mailing address

24 EAST MAIN ST
WILLIAMSTON SC
29697
US

V. Phone/Fax

Practice location:
  • Phone: 864-847-6020
  • Fax: 864-847-6007
Mailing address:
  • Phone: 864-847-6020
  • Fax: 864-847-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1743
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1594
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20856
License Number StateSC

VIII. Authorized Official

Name: DR. JACK D WISE JR.
Title or Position: PRESIDENT
Credential: DC
Phone: 864-847-6020