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General NPI Number Information
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NPI Number | 1346456498
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Entity Type | Organization
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Legal Business Name | WICKISER CLINIC OF CHIROPRACTIC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/25/2008
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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 | 864-224-0246
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Fax | 864-224-2524
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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 | 864-224-0246
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Fax | 864-224-2524
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Authorized Official
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Title or Position | OWNER
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Name | GARY L WICKISER
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Credential | D.C.
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Telephone | 864-224-0246
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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 |
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License Number State |
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