Healthcare Provider Details

I. General information

NPI: 1427207182
Provider Name (Legal Business Name): CHIROPRACTIC HEALTH & WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SCHOOL ST. SUITE 105
BRISTOL VT
05443
US

IV. Provider business mailing address

14 SCHOOL ST. SUITE 105
BRISTOL VT
05443
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-5588
  • Fax: 802-453-7878
Mailing address:
  • Phone: 802-453-5588
  • Fax: 802-453-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0060001148
License Number StateVT

VIII. Authorized Official

Name: THAYER R OSBORNE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 802-453-5588