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General NPI Number Information
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NPI Number | 1811869589
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Entity Type | Organization
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Legal Business Name | WISE CHOICE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 124 SAVANNAH AVE STE 1G
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City | STATESBORO
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State | GA
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Zip | 30458-7149
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Country | US
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Telephone | 912-486-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 144 JABEZ JONES RD
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City | GUYTON
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State | GA
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Zip | 31312-6023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL LOGAN WISE
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Credential | DC
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Telephone | 912-433-8788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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