Provider Demographics
NPI:1952425175
Name:DR. J CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:DR. J CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-776-1520
Mailing Address - Street 1:642 CROSS LANES DR
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1163
Mailing Address - Country:US
Mailing Address - Phone:304-776-1520
Mailing Address - Fax:304-776-1521
Practice Address - Street 1:642 CROSS LANES DR
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1163
Practice Address - Country:US
Practice Address - Phone:304-776-1520
Practice Address - Fax:304-776-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV91087OtherUNICARE
WV1060823OtherAMERICAN SPECIALTY HEALTH
WVAS40510400001OtherCIGNA
WV3810002674Medicaid
WV7509681OtherAETNA
WV306672OtherCARELINK
WV7509681OtherAETNA
WV306672OtherCARELINK
WV7509681OtherAETNA
WV9353941Medicare PIN