MEDICARE: DRAGONFLY WELLNESS CENTER, 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	171100000X	Acupuncturist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1790081875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAGONFLY WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	264 LATITUDE LN STE 103
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-8129
Country	:	US
Telephone Number	:	803-746-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 LATITUDE LN STE 103
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-8129
Country	:	US
Telephone Number	:	803-746-5700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCIA LYNNE NIBERT
Credential	:	D.C.
Telephone Number	:	803-746-5700

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	06/22/2021

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