Healthcare Provider Details

I. General information

NPI: 1578634218
Provider Name (Legal Business Name): MARYLOUISE SCHULTZ WISE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/01/2019
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 TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1594
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: