Healthcare Provider Details

I. General information

NPI: 1326111071
Provider Name (Legal Business Name): COMMONWEALTH CHIROPRACTIC CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 KY ROUTE 321
PRESTONSBURG KY
41653-9102
US

IV. Provider business mailing address

1827 KY ROUTE 321
PRESTONSBURG KY
41653-9102
US

V. Phone/Fax

Practice location:
  • Phone: 606-889-9222
  • Fax: 606-886-1605
Mailing address:
  • Phone: 606-889-9222
  • Fax: 606-886-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4265
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4265
License Number StateKY

VIII. Authorized Official

Name: DR. CHARLES R. SALYERS II
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 606-889-9222