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General NPI Number Information
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NPI Number | 1750599767
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Entity Type | Organization
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Legal Business Name | DISCOVER SPECIFIC CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 1216 6TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-2312
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Country | US
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Telephone | 304-523-3333
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Fax | 304-523-3330
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Provider Business Mailing Address
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Address Line | 1216 6TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-2312
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Country | US
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Telephone | 304-523-3333
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Fax | 304-523-3330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIMMY HERBERT BLANTON
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Credential | D.C.
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Telephone | 304-523-3333
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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 | 668
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License Number State | WV
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