Healthcare Provider Details

I. General information

NPI: 1194948968
Provider Name (Legal Business Name): PRIEM CHIROPRACTIC AND PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 THIRD ST
NEW MARTINSVILLE WV
26155-1401
US

IV. Provider business mailing address

661 THIRD ST
NEW MARTINSVILLE WV
26155-1401
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-6824
  • Fax: 304-455-6825
Mailing address:
  • Phone: 304-455-6824
  • Fax: 304-455-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number656
License Number StateWV

VIII. Authorized Official

Name: DR. EDWARD JAMES PRIEM
Title or Position: PRESIDENT
Credential: DC PT DPT
Phone: 304-455-6824