Provider Demographics
NPI:1427598127
Name:VT PHYSICAL MEDICINE PLLC
Entity Type:Organization
Organization Name:VT PHYSICAL MEDICINE PLLC
Other - Org Name:MILTON CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-651-3196
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:165 ROUTE 7 SOUTH UNIT 101
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-0125
Mailing Address - Country:US
Mailing Address - Phone:315-651-3196
Mailing Address - Fax:
Practice Address - Street 1:165 ROUTE 7 S
Practice Address - Street 2:UNIT 101
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3605
Practice Address - Country:US
Practice Address - Phone:315-651-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0127976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty