Provider Demographics
NPI:1821173493
Name:CARLTON & HARRIS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CARLTON & HARRIS CHIROPRACTIC INC
Other - Org Name:DAVIS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-736-4111
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0430
Mailing Address - Country:US
Mailing Address - Phone:304-736-4111
Mailing Address - Fax:304-736-0334
Practice Address - Street 1:6430 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1240
Practice Address - Country:US
Practice Address - Phone:304-736-4111
Practice Address - Fax:304-736-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
001711097OtherBCBS GROUP ID NUMBER
WV0201267000Medicaid
9312831Medicare ID - Type UnspecifiedMEDICARE