Provider Demographics
NPI:1497198709
Name:LITTLE RIVER CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:LITTLE RIVER CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-253-7411
Mailing Address - Street 1:996 S MAIN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-5195
Mailing Address - Country:US
Mailing Address - Phone:802-253-7411
Mailing Address - Fax:
Practice Address - Street 1:996 S MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-5195
Practice Address - Country:US
Practice Address - Phone:802-253-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2414Medicaid
VTOVN2414Medicaid