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General NPI Number Information
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NPI Number | 1154713170
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Entity Type | Organization
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Legal Business Name | SUMMIT CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 69 CENTER RD
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-2622
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Country | US
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Telephone | 802-662-1047
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Fax |
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Provider Business Mailing Address
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Address Line | 69 CENTER RD
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-2622
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Country | US
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Telephone | 802-662-1047
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. TILYR ALFRED DUNKLOW
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Credential | D.C., B.S.
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Telephone | 802-662-1047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006.0109165
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006.0109638
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License Number State | VT
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