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General NPI Number Information
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NPI Number | 1821143579
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Entity Type | Organization
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Legal Business Name | VINCENT CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 N. TYLER ST
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City | MORGANTOWN
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State | KY
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Zip | 42261
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Country | US
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Telephone | 270-526-4613
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 157
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City | MORGANTOWN
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State | KY
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Zip | 42261-0157
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Country | US
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Telephone | 270-526-4613
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | LARRY DEAN VINCENT
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Credential | D.C.
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Telephone | 270-526-4613
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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 | 4554
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License Number State | KY
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