Provider Demographics
NPI:1740575711
Name:CORE CHIROPRACTIC AND WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC AND WELLNESS CENTER, INC.
Other - Org Name:CORE CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-344-1055
Mailing Address - Street 1:16 W CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-2002
Mailing Address - Country:US
Mailing Address - Phone:540-344-1055
Mailing Address - Fax:540-344-7964
Practice Address - Street 1:16 W CHURCH AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-2002
Practice Address - Country:US
Practice Address - Phone:540-344-1055
Practice Address - Fax:540-344-7964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty