Provider Demographics
NPI:1225210172
Name:WORLDWIDE CHIROPRACTIC & SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:WORLDWIDE CHIROPRACTIC & SPORTS MEDICINE INC
Other - Org Name:WORLDWIDE CHIROPRACTIC & PERFORMANCE ENHANCING CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:THAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-988-1922
Mailing Address - Street 1:7717 SISSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SISSONVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25320-9522
Mailing Address - Country:US
Mailing Address - Phone:304-988-1922
Mailing Address - Fax:304-988-0130
Practice Address - Street 1:7717 SISSONVILLE DR
Practice Address - Street 2:
Practice Address - City:SISSONVILLE
Practice Address - State:WV
Practice Address - Zip Code:25320-9522
Practice Address - Country:US
Practice Address - Phone:304-988-1922
Practice Address - Fax:304-988-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV554261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9374041Medicare PIN
U48657Medicare UPIN