Provider Demographics
NPI:1912269960
Name:ADDISON COUNTY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:ADDISON COUNTY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:802-877-3567
Mailing Address - Street 1:56 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1309
Mailing Address - Country:US
Mailing Address - Phone:802-877-3567
Mailing Address - Fax:
Practice Address - Street 1:56 GREEN ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1309
Practice Address - Country:US
Practice Address - Phone:802-877-3567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty