MEDICARE: MIDLAND CHIROPRACTIC AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	984	WV

General Provider Information

NPI Number	:	1013415629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLAND CHIROPRACTIC AND WELLNESS

Provider Business Mailing Address
First Line	:	332 E MAIN ST
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-1508
Country	:	US
Telephone Number	:
Fax Number	:	681-233-0001

Provider Business Practice Location Address
First Line	:	332 E MAIN ST
Second Line	:
City	:	MILTON
State	:	WV
Zip	:	25541-1508
Country	:	US
Telephone Number	:	304-948-5979
Fax Number	:	681-233-0001

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW LANE HARBOUR
Credential	:	DC
Telephone Number	:	304-948-5979

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	01/29/2018

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Directions to “MIDLAND CHIROPRACTIC AND WELLNESS ” Practice Location

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