Provider Demographics
NPI:1528113362
Name:ANDERSON WELLNESS CENTER
Entity type:Organization
Organization Name:ANDERSON WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GELES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-617-9300
Mailing Address - Street 1:1704 E GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7914
Mailing Address - Country:US
Mailing Address - Phone:864-617-9300
Mailing Address - Fax:
Practice Address - Street 1:1704 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7914
Practice Address - Country:US
Practice Address - Phone:864-617-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDCH2663Medicaid
SCU87671Medicare UPIN
SDCH2663Medicaid