| Organization Name: | MOUNTAIN STATE SPINAL CARE |
| NPI Number: | 1861609638 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LUCAS CHADD WATTERSON (PARTNER) |
| Mailing Address: | 965 Hartman Run Rd Suite 1101 Morgantown |
| State: | WV US |
| Postal Code: | 265053791 |
| Phone Number: | 3042927740 |
| Fax Number: | 3042927741 |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | 770 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WV |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |