Provider Demographics
NPI:1306208731
Name:CHIROPRACTIC FIRST OF SWVA ABINGDON
Entity Type:Organization
Organization Name:CHIROPRACTIC FIRST OF SWVA ABINGDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-254-4622
Mailing Address - Street 1:121 RUSSELL RD NW STE 1
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2758
Mailing Address - Country:US
Mailing Address - Phone:276-525-1777
Mailing Address - Fax:
Practice Address - Street 1:121 RUSSELL RD NW STE 1
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2758
Practice Address - Country:US
Practice Address - Phone:276-525-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556437261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty