Mountainside Chiropractic
Organization Active NPI Chiropractor · East Thetford, VT
NPI 1386235307 · NPPES record last updated Nov 5, 2023
Key facts
- NPI
- 1386235307
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- MOUNTAINSIDE CHIROPRACTIC
- Practice address
- 321 Route 113
East Thetford, VT 05043 - Phone
- (802) 565-0424
- NPI assigned
- Feb 2, 2021
- Organization subpart
- No
Authorized official
- Name
- Bonny R Payne
- Title
- Owner
- Phone
- (802) 565-0424
Practitioners 3
-
Steven Mustoe, D.C.
-
Bonny Payne, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210308000162 | VT | Part B Supplier - Clinic/Group Practice | 4789090325 |
Receives reassigned benefits from 3 practitioners Practice locations: East Thetford, VT |
National Provider Directory
Locations
321 Route 113
East Thetford, VT 05043
Phone (802) 565-0424
1461 Blood Brook Rd
Fairlee, VT 05045
Phone (267) 370-4465
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes | ||
| Physical Medicine & Rehabilitation Physician |
208100000X |
Addresses
Primary practice location
321 Route 113
East Thetford, VT 05043
Mailing address
PO Box 154
East Thetford, VT 05043-0154
Phone (802) 565-0424
Other names
- Mountainside Community Wellness Center
Other providers in East Thetford, VT
- Amy L Chiriatti
- Erin Catherine Donahue
- Duncan Nichols Licsw
- Kimberly Lawrence Kol
- Sara Lamie
- Robin Bennett Osborne
- David Charles Parella
- Andrea L. Robinson
- Allison Thurston
- Alicia Joy Willette
All providers in East Thetford, VT · Chiropractor in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.