Provider Demographics
NPI:1316019805
Name:CHAMPLAIN CHIROPRACTIC SERVICES P.C.
Entity Type:Organization
Organization Name:CHAMPLAIN CHIROPRACTIC SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-878-2191
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-0060
Mailing Address - Country:US
Mailing Address - Phone:802-878-2191
Mailing Address - Fax:802-878-0265
Practice Address - Street 1:2031 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-878-2191
Practice Address - Fax:802-878-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060000712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTCHAM00029334OtherBLUE CROSS BLUE SHIELD
VTVT8797Medicare ID - Type UnspecifiedCHIROPRACTIC