Provider Demographics
NPI:1760413454
Name:EDDY CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:EDDY CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-375-6000
Mailing Address - Street 1:443 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-1247
Mailing Address - Country:US
Mailing Address - Phone:304-375-6000
Mailing Address - Fax:304-375-6043
Practice Address - Street 1:443 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-1247
Practice Address - Country:US
Practice Address - Phone:304-375-6000
Practice Address - Fax:304-375-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001711240OtherBCBS
OH2299178OtherMEDICAID
WV001711240OtherBCBS