Healthcare Provider Details

I. General information

NPI: 1255544045
Provider Name (Legal Business Name): COTTRELL FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 GOFF MOUNTAIN RD
CROSS LANES WV
25313-1434
US

IV. Provider business mailing address

127 GOFF MOUNTAIN RD
CROSS LANES WV
25313-1434
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-7290
  • Fax: 304-776-8058
Mailing address:
  • Phone: 304-776-7290
  • Fax: 304-776-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number671
License Number StateWV

VIII. Authorized Official

Name: DR. SHAWN A COTTRELL
Title or Position: OWNER
Credential: D.C.
Phone: 304-776-7290