MEDICARE: WISE CHIROPRACTIC AND 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	111NR0400X	Rehabilitation Chiropractor	3484	SC
2	111N00000X	Chiropractor	2549	SC

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	:	1932330107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE CHIROPRACTIC AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1400 FERNWOOD GLENDALE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-3043
Country	:	US
Telephone Number	:	864-585-5558
Fax Number	:	864-585-9888

Provider Business Practice Location Address
First Line	:	1400 FERNWOOD GLENDALE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-3043
Country	:	US
Telephone Number	:	864-585-5558
Fax Number	:	864-585-9888

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. NICHOLAS ALEXANDER WISE
Credential	:	D.C.
Telephone Number	:	864-585-5558

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	08/05/2009

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