Healthcare Provider Details

I. General information

NPI: 1801243084
Provider Name (Legal Business Name): THE CHIROPRACTIC CARE CENTER OF MORGANTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GREENBAG RD
MORGANTOWN WV
26508-1589
US

IV. Provider business mailing address

705 GREENBAG RD
MORGANTOWN WV
26508-1589
US

V. Phone/Fax

Practice location:
  • Phone: 304-292-2211
  • Fax: 304-292-2282
Mailing address:
  • Phone: 304-292-2211
  • Fax: 304-292-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JARED SURBAUGH
Title or Position: OWNER/D.C.
Credential: D.C.
Phone: 304-292-2211