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General NPI Number Information
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NPI Number | 1871924373
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Entity Type | Organization
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Legal Business Name | DR. J CHIROPRACTIC & WELLNESS CENTER
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 642 CROSS LANES DR
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City | NITRO
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State | WV
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Zip | 25143-1163
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Country | US
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Telephone | 304-776-1520
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Fax | 304-776-1521
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Provider Business Mailing Address
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Address Line | 642 CROSS LANES DR
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City | NITRO
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State | WV
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Zip | 25143-1163
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Country | US
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Telephone | 304-776-1520
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Fax | 304-776-1521
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JAY LEE MCCLANAHAN
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Credential | DC
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Telephone | 304-776-1520
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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 | 828
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License Number State | WV
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