Elite Wellness Center LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ELITE WELLNESS CENTER LLC

Practice address

12 Groce Rd
Lyman, SC 29365-1631

Phone

(864) 439-1345

Fax

(864) 439-1346

NPI assigned

Nov 28, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Prime, DC

Title

Chiropractor

Phone

(704) 473-4653

Specialties & licenses 1

Addresses

Other names 1

• Bruce Wellness Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587600000000",
    "number": "1578033965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 GROCE RD",
            "city": "LYMAN",
            "state": "SC",
            "postal_code": "293651631",
            "telephone_number": "864-439-1345",
            "fax_number": "864-439-1346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 GROCE RD",
            "city": "LYMAN",
            "state": "SC",
            "postal_code": "293651631",
            "telephone_number": "864-439-1345",
            "fax_number": "864-439-1346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-28",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A",
        "authorized_official_last_name": "PRIME",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "704-473-4653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bruce Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bruce Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.