Provider Demographics
NPI:1255544045
Name:COTTRELL FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:COTTRELL FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-776-7290
Mailing Address - Street 1:127 GOFF MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1434
Mailing Address - Country:US
Mailing Address - Phone:304-776-7290
Mailing Address - Fax:304-776-8058
Practice Address - Street 1:127 GOFF MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1434
Practice Address - Country:US
Practice Address - Phone:304-776-7290
Practice Address - Fax:304-776-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV671111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2207501000Medicaid
WV2207501000Medicaid
WVCO0854262Medicare ID - Type Unspecified