Healthcare Provider Details

I. General information

NPI: 1477626877
Provider Name (Legal Business Name): DYLAN LEVESQUE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EAST VALLEY STREET
ABINGDON VA
24210
US

IV. Provider business mailing address

220 EAST VALLEY STREET
ABINGDON VA
24210
US

V. Phone/Fax

Practice location:
  • Phone: 276-676-3111
  • Fax: 276-676-2778
Mailing address:
  • Phone: 276-676-3111
  • Fax: 276-676-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001589
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: