Provider Demographics
NPI:1396749784
Name:ERWIN, ANTHONY D (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:ERWIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RENARD RUN
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8714
Mailing Address - Country:US
Mailing Address - Phone:304-757-2860
Mailing Address - Fax:
Practice Address - Street 1:3551 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9054
Practice Address - Country:US
Practice Address - Phone:304-757-7668
Practice Address - Fax:304-757-9045
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
WV821111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004499Medicaid
WV3810004499Medicaid
WVER-4164121Medicare ID - Type Unspecified