| NPI | 1215158548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LEE WICKISER Owner Dc 864-224-0283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: MI 645) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 645) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |