| |
4710 Chimney Dr Ste H, Charleston, WV 25302-4841 | |
(304) 965-2458 | |
(304) 965-2258 |
Full Name | |
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Type | Facility |
Speciality | Specialist |
Location | 4710 Chimney Dr Ste H, Charleston, West Virginia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1366548950 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 752 (West Virginia) | Primary |
171100000X | Acupuncturist | (* (Not Available)) | Primary |
174400000X | Specialist | (* (Not Available)) | Primary |
Provider Name | Anthony S Collias |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1659477248 PECOS PAC ID: 3072619923 Enrollment ID: I20120419000800 |
Provider Name | John Paul Tupta |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1780231530 PECOS PAC ID: 2567894306 Enrollment ID: I20230413000468 |
Mailing Address | Practice Location Address |
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4710 Chimney Dr Ste H, Charleston, WV 25302-4841 Ph: (304) 965-2458 | 4710 Chimney Dr Ste H, Charleston, WV 25302-4841 Ph: (304) 965-2458 |