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General NPI Number Information
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NPI Number | 1942643481
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Entity Type | Organization
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Legal Business Name | MISHOE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 3102 CHESTERFIELD AVE
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City | CHARLESTON
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State | WV
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Zip | 25304-1214
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Country | US
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Telephone | 304-346-6688
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Fax | 304-346-6688
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Provider Business Mailing Address
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Address Line | 3102 CHESTERFIELD AVE
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City | CHARLESTON
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State | WV
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Zip | 25304-1214
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Country | US
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Telephone | 304-346-6688
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Fax | 304-346-6688
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Authorized Official
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Title or Position | OWNER
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Name | JULIA C MISHOE
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Credential | DC
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Telephone | 304-346-6688
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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 | 936
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License Number State | WV
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