MEDICARE: ON-SITE CHIROPRACTIC WV PLLC

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

General Provider Information

NPI Number	:	1467118349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON-SITE CHIROPRACTIC WV PLLC

Provider Business Mailing Address
First Line	:	1294 VALLEY RD
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-4800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1294 VALLEY RD
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-4800
Country	:	US
Telephone Number	:	540-877-0122
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. LESLIE HILES
Credential	:	DC
Telephone Number	:	540-877-0122

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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