=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952487563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORT CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 12/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 CRACKER BARREL DRIVE SUITE 200
-----------------------------------------------------
City | BARBOURSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25504-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-733-4616
-----------------------------------------------------
Fax | 304-733-4818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SUITE 200 99 CRACKER BARREL DRIVE
-----------------------------------------------------
City | BARBOURSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25504-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-733-4616
-----------------------------------------------------
Fax | 304-733-4818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DC/OWNER
-----------------------------------------------------
Name | DR. BRETT A SHORT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 304-733-4616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 545
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------