Provider Demographics
NPI:1154507424
Name:AUGUSTA WAYNESBORO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:AUGUSTA WAYNESBORO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KNIZNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-943-1434
Mailing Address - Street 1:2016 GOOSE CREEK ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-8501
Mailing Address - Country:US
Mailing Address - Phone:540-943-1434
Mailing Address - Fax:540-943-5292
Practice Address - Street 1:2016 GOOSE CREEK ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-8501
Practice Address - Country:US
Practice Address - Phone:540-943-1434
Practice Address - Fax:540-943-5292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUGUSTO WAYNESBORO CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-16
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09525Medicare PIN