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General NPI Number Information
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NPI Number | 1215158548
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Entity Type | Organization
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Legal Business Name | DMX IMAGING OF ANDERSON
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3618 E RIVER ST
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City | ANDERSON
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State | SC
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Zip | 29621-7334
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Country | US
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Telephone | 864-224-0283
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Fax |
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Provider Business Mailing Address
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Address Line | 3618 E RIVER ST
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City | ANDERSON
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State | SC
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Zip | 29621-7334
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Country | US
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Telephone | 864-224-0283
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Fax |
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Authorized Official
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Title or Position | OWNER DC
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Name | MR. GARY LEE WICKISER
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Credential |
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Telephone | 864-224-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 645
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 645
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License Number State | MI
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