Provider Demographics
NPI:1396936894
Name:COOMBS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:COOMBS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-943-0124
Mailing Address - Street 1:55 DON KNOTTS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-6805
Mailing Address - Country:US
Mailing Address - Phone:304-943-0124
Mailing Address - Fax:
Practice Address - Street 1:55 DON KNOTTS BLVD SUITE 4
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-6805
Practice Address - Country:US
Practice Address - Phone:304-943-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty