Provider Demographics
NPI:1356613780
Name:WARNER CHIROPRACTIC OFFICE, PC
Entity type:Organization
Organization Name:WARNER CHIROPRACTIC OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:OLSON
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-963-0395
Mailing Address - Street 1:305 ALLEGHENY ST.
Mailing Address - Street 2:P.O. BOX 1045
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1045
Mailing Address - Country:US
Mailing Address - Phone:276-202-2225
Mailing Address - Fax:276-964-2225
Practice Address - Street 1:305 ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1045
Practice Address - Country:US
Practice Address - Phone:276-202-2225
Practice Address - Fax:276-964-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556501111N00000X
VA0104556270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV12148Medicare UPIN
VAV01348Medicare UPIN
VA005429W98Medicare PIN
VA012714W98Medicare PIN