=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568173060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW ERA HEALTH CO., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2022
-----------------------------------------------------
Last Update Date | 12/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 GRAND CENTRAL AVE STE 108
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26105-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-893-9586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 GRAND CENTRAL AVE STE 108
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26105-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR / OWNER
-----------------------------------------------------
Name | DR. STEPHEN T. ROUSH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 304-210-3793
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------