Provider Demographics
NPI:1770592156
Name:APPALACHIAN CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:APPALACHIAN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-733-4616
Mailing Address - Street 1:99 CRACKER BARREL DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-733-4616
Mailing Address - Fax:304-733-4818
Practice Address - Street 1:99 CRACKER BARREL DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-4616
Practice Address - Fax:304-733-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131767000Medicaid
WVU17274Medicare UPIN
SH0687844Medicare PIN