MEDICARE: BRAIN RESTORATION CLINIC, PLLC

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	200601910	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871912667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN RESTORATION CLINIC, PLLC

Provider Business Mailing Address
First Line	:	1040 EDGEWATER CORP PKWY
Second Line	:	SUITE 106
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-4514
Country	:	US
Telephone Number	:	704-541-9117
Fax Number	:	704-541-9137

Provider Business Practice Location Address
First Line	:	1040 EDGEWATER CORP PKWY
Second Line	:	SUITE 106
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-4514
Country	:	US
Telephone Number	:	704-541-9117
Fax Number	:	704-541-9137

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEAN-RONEL CORBIER
Credential	:	M.D.
Telephone Number	:	704-541-9117

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	08/05/2015

Similar Medicare Providers

1740288323 — AMIT G SHAH MD
Practice Location Address:

1040 EDGEWATER CORP PKWY STE 101
INDIAN LAND, SC
29707-4514

Practice Phone: 803-548-7007
Practice Fax: 803-802-2015

1225193105 — JEAN-RONEL CORBIER MD
Practice Location Address:

1040 EDGEWATER CORP PKWY , SUITE 106
INDIAN LAND, SC
29707-4514

Practice Phone: 704-541-9117
Practice Fax: 704-541-9137

1962720342 — KAREN E PRESTON CRNP
Practice Location Address:

1040 EDGEWATER CORP PKWY , SUITE 106
INDIAN LAND, SC
29707-4514

Practice Phone: 704-541-9117
Practice Fax: 704-541-9137

1497144778 — MEDICINE WHEEL HEALING ART, LLC
Practice Location Address:

1040 EDGEWATER CORP PKWY STE 101
INDIAN LAND, SC
29707-4514

Practice Phone: 704-905-8834
Practice Fax:

1578926812 — TOTAL HEALTH INDUSTRIES NC, LLC
Practice Location Address:

1040 EDGEWATER CORPORATE PKWY , SUITE 104
INDIAN LAND, SC
29707-4514

Practice Phone: 704-626-2550
Practice Fax: 704-626-2550

1316607583 — MEGAN BLACKWELDER KEENER NP
Practice Location Address:

1040 EDGEWATER CORPORATE PKWY
INDIAN LAND, SC
29707-4514

Practice Phone: 803-547-8660
Practice Fax: 803-650-3880

Directions to “BRAIN RESTORATION CLINIC, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.