Provider Demographics
NPI:1780787663
Name:ALMOST HEAVEN FAMILY CHIROPRACTIC HEALTH CARE CENTER INC.
Entity type:Organization
Organization Name:ALMOST HEAVEN FAMILY CHIROPRACTIC HEALTH CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:RUNDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-367-1131
Mailing Address - Street 1:2703 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3450
Mailing Address - Country:US
Mailing Address - Phone:304-367-1131
Mailing Address - Fax:304-367-1141
Practice Address - Street 1:2703 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3450
Practice Address - Country:US
Practice Address - Phone:304-367-1131
Practice Address - Fax:304-367-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002055Medicaid
WVWV00820OtherTHE HEALTH PLAN
WV11430994OtherCAQH
WV4282386OtherCIGNA
WV3810002055Medicaid
WVWV00820OtherTHE HEALTH PLAN
WV11430994OtherCAQH