Organization
FORM X FUNCTION WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH DAVID PELICANO DC (CEO)
(864) 293-4213
Entity
Organization
Contact information
Practice address
6 SEVIER ST, GREENVILLE, SC 29605
(864) 214-6163
Mailing address
420 PEACH GROVE PL, MAULDIN, SC 29662-3406
(864) 293-4213
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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