Provider Demographics
NPI:1457520355
Name:HEDGESVILLE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HEDGESVILLE CHIROPRACTIC CLINIC
Other - Org Name:BERKELEY SPRINGS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KULUS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:304-258-2000
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-0822
Mailing Address - Country:US
Mailing Address - Phone:304-258-2000
Mailing Address - Fax:304-258-2001
Practice Address - Street 1:1644 VALLEY RD
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-4803
Practice Address - Country:US
Practice Address - Phone:304-258-2000
Practice Address - Fax:304-258-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9320432Medicare PIN