Provider Demographics
NPI:1114575651
Name:CLOVERLEAF CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CLOVERLEAF CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-523-7128
Mailing Address - Street 1:1 CLOVERLEAF SQ STE A2
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-2758
Mailing Address - Country:US
Mailing Address - Phone:276-523-7128
Mailing Address - Fax:276-523-7213
Practice Address - Street 1:1 CLOVERLEAF SQ STE A2
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-2758
Practice Address - Country:US
Practice Address - Phone:276-523-7128
Practice Address - Fax:276-523-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center