Healthcare Provider Details

I. General information

NPI: 1942504113
Provider Name (Legal Business Name): MCCARTER WELLNESS DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 EMERSON AVE
PARKERSBURG WV
26104-1217
US

IV. Provider business mailing address

4315 EMERSON AVE
PARKERSBURG WV
26104-1217
US

V. Phone/Fax

Practice location:
  • Phone: 304-428-8300
  • Fax: 304-428-5087
Mailing address:
  • Phone: 304-428-8300
  • Fax: 304-428-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number710
License Number StateWV

VIII. Authorized Official

Name: DENA WATSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-428-8300