Provider Demographics
NPI:1952347775
Name:CHITTENDEN COUNTY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CHITTENDEN COUNTY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-879-3900
Mailing Address - Street 1:20 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3154
Mailing Address - Country:US
Mailing Address - Phone:802-879-3900
Mailing Address - Fax:802-879-3511
Practice Address - Street 1:20 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3154
Practice Address - Country:US
Practice Address - Phone:802-879-3900
Practice Address - Fax:802-879-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty