Healthcare Provider Details

I. General information

NPI: 1700181393
Provider Name (Legal Business Name): BLUE RIDGE FAMILY CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 VALLEY ST E
ABINGDON VA
24210-2910
US

IV. Provider business mailing address

220 VALLEY ST E
ABINGDON VA
24210-2910
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: DR. DYLAN DANIEL LEVESQUE
Title or Position: OWNER
Credential: DC
Phone: 276-676-3111