Provider Demographics
NPI: | 1821485814 |
---|---|
Name: | MILTON CHIROPRACTIC CENTER |
Entity Type: | Organization |
Organization Name: | MILTON CHIROPRACTIC CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TIMOTHY |
Authorized Official - Middle Name: | HIDEYO |
Authorized Official - Last Name: | PICKENS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 802-893-1070 |
Mailing Address - Street 1: | PO BOX 125 |
Mailing Address - Street 2: | |
Mailing Address - City: | MILTON |
Mailing Address - State: | VT |
Mailing Address - Zip Code: | 05468-0125 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 802-893-1070 |
Mailing Address - Fax: | 802-893-0668 |
Practice Address - Street 1: | 165 ROUTE 7 S UNIT 101 |
Practice Address - Street 2: | |
Practice Address - City: | MILTON |
Practice Address - State: | VT |
Practice Address - Zip Code: | 05468-3605 |
Practice Address - Country: | US |
Practice Address - Phone: | 802-893-1070 |
Practice Address - Fax: | 802-893-0668 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-04-17 |
Last Update Date: | 2015-04-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VT | 006.0102119 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |