47D2295695 CLIA NUMBER - LIGHTHOUSE CHIROPRACTIC/VERMONT DOT PHYSICALS

Laboratory Demographics

CLIA Number: 47D2295695

Facility Name: LIGHTHOUSE CHIROPRACTIC/VERMONT DOT PHYSICALS

Facility Address:
8 FERRY RD
SOUTH HERO, VT
ZIP 05486
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Facility Phone Number: 802 372-5800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821158718

Taxonomy: 111N00000X - Chiropractor
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.

CLIA Record

Field Name	Field Value
CLIA Number	47D2295695
LAB Type	Physician Office
Facility Name	LIGHTHOUSE CHIROPRACTIC/VERMONT DOT PHYSICALS
Street	8 FERRY RD
City	SOUTH HERO
State	VT
ZIP	05486
Phone	802 372-5800
CertificateType	4
CertificateEffectiveDate	12/15/2023
CertificateExpirationDate	12/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024