Provider Demographics
NPI:1790085488
Name:VALLEY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:VALLEY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COLLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-965-2458
Mailing Address - Street 1:4710 CHIMNEY DR
Mailing Address - Street 2:STE H
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4843
Mailing Address - Country:US
Mailing Address - Phone:304-965-2458
Mailing Address - Fax:304-965-2258
Practice Address - Street 1:100 ERSKINE LN
Practice Address - Street 2:STE B
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9751
Practice Address - Country:US
Practice Address - Phone:304-965-2458
Practice Address - Fax:304-965-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty