Provider Demographics
NPI:1689773327
Name:VANSCOY CHIROPRACTIC CORPORATION HOLISTIC HEALTH CENTER
Entity Type:Organization
Organization Name:VANSCOY CHIROPRACTIC CORPORATION HOLISTIC HEALTH CENTER
Other - Org Name:TEAYS VALLEY MEDICINE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:VANSCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-760-1180
Mailing Address - Street 1:3761 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9705
Mailing Address - Country:US
Mailing Address - Phone:307-476-0118
Mailing Address - Fax:304-760-1189
Practice Address - Street 1:3761 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9705
Practice Address - Country:US
Practice Address - Phone:307-476-0118
Practice Address - Fax:304-760-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV729111NX0800X
WV940204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCH0555OtherRAILROAD MEDICARE NUMBER
WV4000457000Medicaid
WV9309691OtherMEDICARE GROUP NUMBER
WV4000457000Medicaid