Provider Demographics
NPI:1144309444
Name:WARDLOW, VINCENT EDWARD (DC)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:EDWARD
Last Name:WARDLOW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 EDGAR AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1258
Mailing Address - Country:US
Mailing Address - Phone:304-645-6524
Mailing Address - Fax:304-645-6527
Practice Address - Street 1:631 EDGAR AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1258
Practice Address - Country:US
Practice Address - Phone:304-645-6524
Practice Address - Fax:304-645-6527
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52902Medicare UPIN