Provider Demographics
NPI:1316094378
Name:ADVANCED WELLNESS CENTER
Entity type:Organization
Organization Name:ADVANCED WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-332-4672
Mailing Address - Street 1:107 ARMORY ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5421
Mailing Address - Country:US
Mailing Address - Phone:843-332-4672
Mailing Address - Fax:843-332-0798
Practice Address - Street 1:107 ARMORY ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5421
Practice Address - Country:US
Practice Address - Phone:843-332-4672
Practice Address - Fax:843-332-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA07500281Medicare PIN