Provider Demographics
NPI:1508039801
Name:BARTLE CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:BARTLE CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARTLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:828-437-0888
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:BARTLE CHIROPRACTIC CLINIC PA
Mailing Address - City:MORGANTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28680-1158
Mailing Address - Country:US
Mailing Address - Phone:828-437-0888
Mailing Address - Fax:828-437-1020
Practice Address - Street 1:621 S GREEN ST SUITE 100
Practice Address - Street 2:BARTLE CHIROPRACTIC CLINIC PA
Practice Address - City:MORGANTOWN
Practice Address - State:NC
Practice Address - Zip Code:28655
Practice Address - Country:US
Practice Address - Phone:828-437-0888
Practice Address - Fax:828-437-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908256Medicaid
NC8908256Medicaid
T64347Medicare UPIN