MEDICARE: VANSCOY CHIROPRACTIC CORPORATION HOLISTIC HEALTH CENTER

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	111NX0800X	Orthopedic Chiropractor	729	WV
2	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	940	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH0555	OTHER	WV	RAILROAD MEDICARE NUMBER
3	9309691	OTHER	WV	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689773327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANSCOY CHIROPRACTIC CORPORATION HOLISTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	3761 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9705
Country	:	US
Telephone Number	:	307-476-0118
Fax Number	:	304-760-1189

Provider Business Practice Location Address
First Line	:	3761 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9705
Country	:	US
Telephone Number	:	307-476-0118
Fax Number	:	304-760-1189

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DARRIN ANDREW VANSCOY
Credential	:	DC
Telephone Number	:	304-760-1180

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/25/2007

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1861927444 — MS. GINA HOLT MSW, LICSW
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3752 TEAYS VALLEY RD
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25526-9705

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1477665768 — EMERY BRAD MCCOY D.O., PLLC
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Directions to “VANSCOY CHIROPRACTIC CORPORATION HOLISTIC HEALTH CENTER ” Practice Location

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