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General NPI Number Information
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NPI Number | 1255544045
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Entity Type | Organization
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Legal Business Name | COTTRELL FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 127 GOFF MOUNTAIN RD
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City | CROSS LANES
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State | WV
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Zip | 25313-1434
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Country | US
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Telephone | 304-776-7290
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Fax | 304-776-8058
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Provider Business Mailing Address
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Address Line | 127 GOFF MOUNTAIN RD
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City | CROSS LANES
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State | WV
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Zip | 25313-1434
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Country | US
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Telephone | 304-776-7290
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Fax | 304-776-8058
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN A COTTRELL
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Credential | D.C.
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Telephone | 304-776-7290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 671
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License Number State | WV
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