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General NPI Number Information
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NPI Number | 1902619315
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Entity Type | Organization
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Legal Business Name | THE WILSON AFFECT
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 5 LAKE CAROLINA WAY STE 280
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City | COLUMBIA
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State | SC
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Zip | 29229-7563
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Country | US
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Telephone | 205-526-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 TURTLE STONE RD
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-9267
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Country | US
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Telephone | 205-526-6060
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Fax |
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Authorized Official
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Title or Position | ONWER
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Name | TANIEKA TA'SHA WILSON-MYERS
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Credential |
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Telephone | 205-526-6060
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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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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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