Provider Demographics
NPI:1407122831
Name:RAINVILLE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:RAINVILLE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-524-4600
Mailing Address - Street 1:25 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-2205
Mailing Address - Country:US
Mailing Address - Phone:802-524-4600
Mailing Address - Fax:802-524-4700
Practice Address - Street 1:25 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-2205
Practice Address - Country:US
Practice Address - Phone:802-524-4600
Practice Address - Fax:802-524-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0084296111N00000X
VT006.0057138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0030413Medicare PIN