Provider Demographics
NPI:1457535510
Name:DC DIAGNOSTIC CENTER PLLC
Entity Type:Organization
Organization Name:DC DIAGNOSTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-776-5920
Mailing Address - Street 1:113 GOFF MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1450
Mailing Address - Country:US
Mailing Address - Phone:304-776-5920
Mailing Address - Fax:304-469-3652
Practice Address - Street 1:113 GOFF MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1450
Practice Address - Country:US
Practice Address - Phone:304-776-5920
Practice Address - Fax:304-469-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty