Healthcare Provider Details

I. General information

NPI: 1336541556
Provider Name (Legal Business Name): JUSTIN VINSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 DAYTON XENIA RD STE A
BEAVERCREEK OH
45434-6393
US

IV. Provider business mailing address

3060 DAYTON XENIA RD STE A
BEAVERCREEK OH
45434-6393
US

V. Phone/Fax

Practice location:
  • Phone: 937-427-2225
  • Fax: 937-405-1078
Mailing address:
  • Phone: 937-427-2225
  • Fax: 937-405-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4451
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: