Provider Demographics
NPI:1457680027
Name:EAGLE HEALTH & WELLNESS, INC.
Entity Type:Organization
Organization Name:EAGLE HEALTH & WELLNESS, INC.
Other - Org Name:CHRISTOPHERCHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-549-4811
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-0757
Mailing Address - Country:US
Mailing Address - Phone:606-549-4811
Mailing Address - Fax:606-549-4814
Practice Address - Street 1:410 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1137
Practice Address - Country:US
Practice Address - Phone:606-549-4811
Practice Address - Fax:606-549-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1975501Medicare PIN