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General NPI Number Information
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NPI Number | 1780034470
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Entity Type | Organization
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Legal Business Name | FULCRUM OSTEOPATHIC WELLNESS, LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 4006 E NORTH ST SUITE C
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City | GREENVILLE
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State | SC
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Zip | 29615-2347
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Country | US
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Telephone | 864-417-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 101 LYTLE ST
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City | GREER
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State | SC
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Zip | 29650-2724
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Country | US
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Telephone | 864-417-5255
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | DR. REBECCA JANE BOWERS
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Credential | D.O.
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Telephone | 864-417-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 37584 DO
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License Number State | SC
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