Healthcare Provider Details

I. General information

NPI: 1093712382
Provider Name (Legal Business Name): SALLY JO MOCK D.C., P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 AMBRIAR PLAZA
AMHERST VA
24521
US

IV. Provider business mailing address

PO BOX 343
AMHERST VA
24521-0343
US

V. Phone/Fax

Practice location:
  • Phone: 434-946-0796
  • Fax: 434-946-0736
Mailing address:
  • Phone: 434-946-0796
  • Fax: 434-946-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104002001
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: