Provider Demographics
NPI:1154713170
Name:SUMMIT CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TILYR
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:DUNKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BS
Authorized Official - Phone:802-662-1047
Mailing Address - Street 1:69 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2622
Mailing Address - Country:US
Mailing Address - Phone:802-662-1047
Mailing Address - Fax:
Practice Address - Street 1:69 CENTER RD
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2622
Practice Address - Country:US
Practice Address - Phone:802-662-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0109638111N00000X
VT006.0109165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty