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General NPI Number Information
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NPI Number | 1336956648
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Entity Type | Organization
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Legal Business Name | INJURY CENTER OF WV
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 130 PROFESSIONAL PL
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City | BRIDGEPORT
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State | WV
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Zip | 26330-4599
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Country | US
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Telephone | 681-519-9779
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 CORPORATE EXCHANGE DR STE 110
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City | COLUMBUS
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State | OH
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Zip | 43231-7689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT JOHN BROOKS
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Credential | DC
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Telephone | 614-619-6965
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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