Provider Demographics
NPI:1104966928
Name:CHIROPRACTIC PHYSICIANS OF WEST VIRGINIA
Entity type:Organization
Organization Name:CHIROPRACTIC PHYSICIANS OF WEST VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-801-1307
Mailing Address - Street 1:3683 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:614-801-1307
Mailing Address - Fax:614-277-3503
Practice Address - Street 1:1101 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8711
Practice Address - Country:US
Practice Address - Phone:304-757-4515
Practice Address - Fax:304-757-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty