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General NPI Number Information
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NPI Number | 1558558049
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Entity Type | Organization
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Legal Business Name | WISE HEALTH SOLUTIONS, LTD.
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 329 BROADWAY ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-5115
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Country | US
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Telephone | 618-244-3370
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Fax | 618-244-3395
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Provider Business Mailing Address
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Address Line | 329 BROADWAY ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-5115
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Country | US
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Telephone | 618-244-3370
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Fax | 618-244-3395
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT LEE WISE
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Credential | D.C.
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Telephone | 618-244-3370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | H63975
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License Number State | IL
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Taxonomy #2
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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 | IL
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