Healthcare Provider Details

I. General information

NPI: 1417053042
Provider Name (Legal Business Name): RIVERVIEW HEALTH CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 GRAND CENTRAL AVE
VIENNA WV
26105
US

IV. Provider business mailing address

1605 GRAND CENTRAL AVE
VIENNA WV
26105
US

V. Phone/Fax

Practice location:
  • Phone: 304-295-5505
  • Fax: 304-295-0503
Mailing address:
  • Phone: 304-295-5505
  • Fax: 304-295-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number702
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002160
License Number StateWV

VIII. Authorized Official

Name: BECKY J MCCALE
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-295-5505