Provider Demographics
NPI:1487803292
Name:WISE CHIROPRACTIC
Entity type:Organization
Organization Name:WISE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:ELWOOD
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-328-2260
Mailing Address - Street 1:517 W MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-6905
Mailing Address - Country:US
Mailing Address - Phone:276-328-2260
Mailing Address - Fax:
Practice Address - Street 1:517 W MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-6905
Practice Address - Country:US
Practice Address - Phone:276-328-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty