Healthcare Provider Details

I. General information

NPI: 1497940563
Provider Name (Legal Business Name): A NEW LEAF FAMILY CHIROPRACTIC AND ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 5TH AVE
HUNTINGTON WV
25701-2207
US

IV. Provider business mailing address

15223 STATE ROUTE 7 S
CROWN CITY OH
45623-8977
US

V. Phone/Fax

Practice location:
  • Phone: 740-208-0388
  • Fax:
Mailing address:
  • Phone: 740-208-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number869
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number869
License Number StateWV

VIII. Authorized Official

Name: DR. THOMAS ALAN BEA
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 740-208-0388