Provider Demographics
NPI:1477675866
Name:CULVER CHIROPRACTIC
Entity Type:Organization
Organization Name:CULVER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-387-7013
Mailing Address - Street 1:988 BEN BOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-9706
Mailing Address - Country:US
Mailing Address - Phone:276-979-4292
Mailing Address - Fax:276-979-4293
Practice Address - Street 1:988 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9706
Practice Address - Country:US
Practice Address - Phone:276-979-4292
Practice Address - Fax:276-979-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98403Medicare UPIN
KYDE7009Medicare ID - Type UnspecifiedRAILROAD
000000322614OtherANTHEM
U98403Medicare UPIN