Provider Demographics
NPI:1750602447
Name:OPEN HART CHIROPRACTIC
Entity type:Organization
Organization Name:OPEN HART CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MINGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-828-1000
Mailing Address - Street 1:610 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1654
Mailing Address - Country:US
Mailing Address - Phone:540-828-1000
Mailing Address - Fax:540-828-3171
Practice Address - Street 1:610 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1654
Practice Address - Country:US
Practice Address - Phone:540-828-1000
Practice Address - Fax:540-828-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104556429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty