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General NPI Number Information
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NPI Number | 1003720574
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Entity Type | Organization
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Legal Business Name | VICTORY SPINAL CARE CLEMSON LLC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 10873 CLEMSON BLVD UNIT 113
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City | SENECA
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State | SC
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Zip | 29678-1397
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Country | US
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Telephone | 814-516-2897
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Fax |
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Provider Business Mailing Address
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Address Line | 1424 KURRE LN
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-2254
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Country | US
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Telephone | 573-334-0100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERED WAYLAND
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Credential | DC
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Telephone | 573-837-9107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | NULL
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