Provider Demographics
NPI:1235527888
Name:WARDLOW CHIROPRACTIC ENTERPRISE, PLLC
Entity Type:Organization
Organization Name:WARDLOW CHIROPRACTIC ENTERPRISE, PLLC
Other - Org Name:FAIRLEA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-645-6524
Mailing Address - Street 1:8747 SENECA TRL S
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8387
Mailing Address - Country:US
Mailing Address - Phone:304-645-6524
Mailing Address - Fax:304-645-6524
Practice Address - Street 1:8747 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8387
Practice Address - Country:US
Practice Address - Phone:304-645-6524
Practice Address - Fax:304-645-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty