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General NPI Number Information
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NPI Number | 1457680027
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Entity Type | Organization
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Legal Business Name | EAGLE HEALTH & WELLNESS, INC.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 410 SYCAMORE ST
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City | WILLIAMSBURG
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State | KY
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Zip | 40769-1137
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Country | US
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Telephone | 606-549-4811
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Fax | 606-549-4814
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Provider Business Mailing Address
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Address Line | PO BOX 757
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City | WILLIAMSBURG
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State | KY
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Zip | 40769-0757
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Country | US
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Telephone | 606-549-4811
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Fax | 606-549-4814
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY MATTHEW CHRISTOPHER
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Credential | DC
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Telephone | 606-549-4811
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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 | 5204
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License Number State | KY
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