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General NPI Number Information
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NPI Number | 1851489009
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Entity Type | Organization
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Legal Business Name | CLINE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 745 RIVERSIDE DR
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City | WELCH
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State | WV
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Zip | 24801-2607
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Country | US
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Telephone | 304-436-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 745 RIVERSIDE DR
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City | WELCH
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State | WV
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Zip | 24801-2607
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Country | US
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Telephone | 304-436-2520
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. MARK C CLINE
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Credential | D.C.
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Telephone | 304-436-2520
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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 | 753
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License Number State | WV
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