Individual
STEPHEN R THAXTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
7717 SISSONVILLE DR, SISSONVILLE, WV 25320-9522
(304) 988-1922
(304) 988-0130
Mailing address
7717 SISSONVILLE DR, SISSONVILLE, WV 25320-9522
(304) 988-1922
(304) 988-0130
Taxonomy
Speciality
Code
Description
License number
State
111NR0200X
Radiology Chiropractor
554
WV
111NR0400X
Rehabilitation Chiropractor
Primary
554
WV
111NS0005X
Sports Physician Chiropractor
554
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010707548
MOUNTAIN STATE
WV
05
—
013224900
—
WV
Enumeration date
05/22/2007
Last updated
03/25/2021
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