Provider Demographics
NPI:1861762742
Name:PAIGE CHRIOPRACTIC AND ACUPUNCTURE PLLC
Entity type:Organization
Organization Name:PAIGE CHRIOPRACTIC AND ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-732-8054
Mailing Address - Street 1:231 BONNET STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-0231
Mailing Address - Country:US
Mailing Address - Phone:802-362-6266
Mailing Address - Fax:802-362-6265
Practice Address - Street 1:231 BONNET STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-0231
Practice Address - Country:US
Practice Address - Phone:802-362-6266
Practice Address - Fax:802-362-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060075005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT12255508OtherCAQH