Healthcare Provider Details

I. General information

NPI: 1700074028
Provider Name (Legal Business Name): FAMILY FIRST CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2696 WHITE HALL BLVD
FAIRMONT WV
26554-8226
US

IV. Provider business mailing address

2696 WHITE HALL BLVD
FAIRMONT WV
26554-8226
US

V. Phone/Fax

Practice location:
  • Phone: 304-333-6668
  • Fax: 304-333-6666
Mailing address:
  • Phone: 304-333-6668
  • Fax: 304-333-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number833
License Number StateWV

VIII. Authorized Official

Name: DR. BRIAN R MENZIES
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 304-333-6668