Healthcare Provider Details

I. General information

NPI: 1740334093
Provider Name (Legal Business Name): ELK RIVER CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ELK ST
GASSAWAY WV
26624-1135
US

IV. Provider business mailing address

615 ELK ST
GASSAWAY WV
26624-1135
US

V. Phone/Fax

Practice location:
  • Phone: 304-364-5225
  • Fax: 304-364-8033
Mailing address:
  • Phone: 304-364-5225
  • Fax: 304-364-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM DWIGHT LOHR JR.
Title or Position: OWNER
Credential: DC
Phone: 304-364-5225