Individual
BRYAN WACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
169 ASHLEY AVE, ROOM 202 MAIN HOSPITAL MSC333, CHARLESTON, SC 29425
(843) 876-7080
Mailing address
169 ASHLEY AVE, ROOM 202 MAIN HOSPITAL MSC333, CHARLESTON, SC 29425
(843) 876-7080
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2023018522
MO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/23/2022
Last updated
04/17/2026
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