Provider Demographics
NPI:1366548950
Name:ELK VALLEY HEALTH & WELLNESS
Entity type:Organization
Organization Name:ELK VALLEY HEALTH & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COLLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-965-2458
Mailing Address - Street 1:4710 CHIMNEY DR STE H
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4841
Mailing Address - Country:US
Mailing Address - Phone:304-965-2458
Mailing Address - Fax:304-965-2258
Practice Address - Street 1:4710 CHIMNEY DR STE H
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4841
Practice Address - Country:US
Practice Address - Phone:304-965-2458
Practice Address - Fax:304-965-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV752111N00000X
171100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV=========OtherTAX ID
9324201Medicare ID - Type UnspecifiedGROUP