Healthcare Provider Details

I. General information

NPI: 1689773327
Provider Name (Legal Business Name): VANSCOY CHIROPRACTIC CORPORATION HOLISTIC HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3761 TEAYS VALLEY RD
HURRICANE WV
25526-9705
US

IV. Provider business mailing address

3761 TEAYS VALLEY RD
HURRICANE WV
25526-9705
US

V. Phone/Fax

Practice location:
  • Phone: 307-476-0118
  • Fax: 304-760-1189
Mailing address:
  • Phone: 307-476-0118
  • Fax: 304-760-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number729
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number940
License Number StateWV

VIII. Authorized Official

Name: DR. DARRIN ANDREW VANSCOY
Title or Position: PRESIDENT
Credential: DC
Phone: 304-760-1180