Provider Demographics
NPI:1841617644
Name:MID-OHIO VALLEY CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:MID-OHIO VALLEY CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-488-7309
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-0058
Mailing Address - Country:US
Mailing Address - Phone:304-488-7309
Mailing Address - Fax:
Practice Address - Street 1:7930 PIKE ST.
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-0040
Practice Address - Country:US
Practice Address - Phone:304-488-7309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV949261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center