Healthcare Provider Details

I. General information

NPI: 1114862299
Provider Name (Legal Business Name): GABRIEL BOOTHE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 REEDY CREEK RD
ABINGDON VA
24210-2436
US

IV. Provider business mailing address

108 REEDY CREEK RD
ABINGDON VA
24210-2436
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-8006
  • Fax: 276-628-6117
Mailing address:
  • Phone: 276-628-8006
  • Fax: 276-628-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104558167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: