Healthcare Provider Details

I. General information

NPI: 1508131152
Provider Name (Legal Business Name): CHIROPRACTIC CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 GREEN MOUNTAIN ROAD
MANCHESTER CENTER VT
05255-1228
US

IV. Provider business mailing address

PO BOX 1228
MANCHESTER CENTER VT
05255-1228
US

V. Phone/Fax

Practice location:
  • Phone: 802-362-3040
  • Fax: 802-362-2811
Mailing address:
  • Phone: 802-362-3040
  • Fax: 802-362-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYMOND CHARLES FOSTER
Title or Position: OWNER
Credential: D.C.
Phone: 802-362-3040