Healthcare Provider Details

I. General information

NPI: 1952347775
Provider Name (Legal Business Name): CHITTENDEN COUNTY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LINCOLN STREET
ESSEX JUNCTION VT
05452-3154
US

IV. Provider business mailing address

20 LINCOLN STREET
ESSEX JUNCTION VT
05452-3154
US

V. Phone/Fax

Practice location:
  • Phone: 802-879-3900
  • Fax: 802-879-3511
Mailing address:
  • Phone: 802-879-3900
  • Fax: 802-879-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006-0001120
License Number StateVT

VIII. Authorized Official

Name: DR. CORY ANDREW PIKE
Title or Position: OWNER
Credential: D.C.
Phone: 802-879-3900