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General NPI Number Information
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NPI Number | 1366678187
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Entity Type | Organization
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Legal Business Name | TRACEY W SELLERS
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 111 CLEBOURNE ST SUITE 120
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City | FORT MILL
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State | SC
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Zip | 29715-1758
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Country | US
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Telephone | 803-746-7313
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Fax | 803-746-7332
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Provider Business Mailing Address
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Address Line | 111 CLEBOURNE ST SUITE 120
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City | FORT MILL
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State | SC
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Zip | 29715-1758
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Country | US
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Telephone | 803-746-7313
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Fax | 803-746-7332
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRACEY WYNNE SELLERS
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Credential | D.C.
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Telephone | 803-746-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3248
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License Number State | SC
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