Provider Demographics
NPI:1386894855
Name:FOLWELL CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:FOLWELL CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-485-9124
Mailing Address - Street 1:3211 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1715
Mailing Address - Country:US
Mailing Address - Phone:304-485-9124
Mailing Address - Fax:304-485-9127
Practice Address - Street 1:3211 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1715
Practice Address - Country:US
Practice Address - Phone:304-485-9124
Practice Address - Fax:304-485-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131769000Medicaid
WV0131769000Medicaid
FO0892051Medicare PIN