Provider Demographics
NPI:1255631404
Name:CROSS TRAINERS CHIROPRACTIC AND WELLNESS CENTER
Entity type:Organization
Organization Name:CROSS TRAINERS CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-789-3153
Mailing Address - Street 1:31454 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-0000
Mailing Address - Country:US
Mailing Address - Phone:304-789-3153
Mailing Address - Fax:
Practice Address - Street 1:31454 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-0000
Practice Address - Country:US
Practice Address - Phone:304-789-3153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty