Healthcare Provider Details

I. General information

NPI: 1811162001
Provider Name (Legal Business Name): APPALACHIAN CHIROPRACTIC CTR. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 SHULER HOLLOW RD
CHILHOWIE VA
24319-5647
US

IV. Provider business mailing address

831 SHULER HOLLOW RD
CHILHOWIE VA
24319-5647
US

V. Phone/Fax

Practice location:
  • Phone: 276-429-2005
  • Fax: 276-646-5112
Mailing address:
  • Phone: 276-646-5112
  • Fax: 276-646-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555564
License Number StateVA

VIII. Authorized Official

Name: DR. BRIAN K WIDENER
Title or Position: PRESIDENT
Credential: DC
Phone: 276-429-2005