Provider Demographics
NPI:1689863474
Name:PTW AND CVD ENTERPRISES LLC
Entity Type:Organization
Organization Name:PTW AND CVD ENTERPRISES LLC
Other - Org Name:RI CHIROPRACTIC HEALTH & REHAB CLINIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:T
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-569-9488
Mailing Address - Street 1:544A CHALKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3618
Mailing Address - Country:US
Mailing Address - Phone:401-569-9488
Mailing Address - Fax:401-808-6388
Practice Address - Street 1:544A CHALKSTONE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3618
Practice Address - Country:US
Practice Address - Phone:401-569-9488
Practice Address - Fax:401-808-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI670397OtherUNITED HEALTH CARE
RI31387OtherBCBSRI