MEDICARE: FULCRUM OSTEOPATHIC WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	37584 DO	SC

General Provider Information

NPI Number	:	1780034470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULCRUM OSTEOPATHIC WELLNESS, LLC

Provider Business Mailing Address
First Line	:	101 LYTLE ST
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-2724
Country	:	US
Telephone Number	:	864-417-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 E NORTH ST
Second Line	:	SUITE C
City	:	GREENVILLE
State	:	SC
Zip	:	29615-2347
Country	:	US
Telephone Number	:	864-417-5255
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETER
Name	:	DR. REBECCA JANE BOWERS
Credential	:	D.O.
Telephone Number	:	864-417-5255

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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