Provider Demographics
NPI:1952487563
Name:SHORT CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SHORT CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-733-4616
Mailing Address - Street 1:SUITE 200 99 CRACKER BARREL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1622
Mailing Address - Country:US
Mailing Address - Phone:304-733-4616
Mailing Address - Fax:304-733-4818
Practice Address - Street 1:99 CRACKER BARREL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1622
Practice Address - Country:US
Practice Address - Phone:304-733-4616
Practice Address - Fax:304-733-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV760111N00000X
WV545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131767000Medicaid
WV1538197702OtherDR SHORT NPI INDIVIDUAL #
WV2202061000Medicaid
WV760OtherDR KNIPP LICENSE #
WV000000223716OtherSHORT ANTHEM #
WV545OtherDR SHORT LICENSE #
WV1255377057OtherDR KNIPP NPI INDIVIDUAL #
WV350047718OtherDR SHORT RAILROAD #
WV4342024OtherAETNA # FOR DR SHORT
WV7073344OtherDR KNIPP AETNA #
WV1059296OtherDR SHORT WC ID
WV3810005988Medicaid
WV1255377057OtherDR KNIPP WC #
WVBC/BSOtherBCBS #
WV000000223714OtherANTHAM DR KNIPP
WVU89294Medicare UPIN
WV3810005988Medicaid