Healthcare Provider Details

I. General information

NPI: 1831694405
Provider Name (Legal Business Name): BEDFORD CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 TURNPIKE RD STE C
BEDFORD VA
24523-1811
US

IV. Provider business mailing address

1029 TURNPIKE RD STE C
BEDFORD VA
24523-1811
US

V. Phone/Fax

Practice location:
  • Phone: 540-586-5860
  • Fax: 540-586-4930
Mailing address:
  • Phone: 540-586-5860
  • Fax: 540-586-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0104557198
License Number StateVA

VIII. Authorized Official

Name: LINDA MARIA SELANDER
Title or Position: OFFICE MANAGER
Credential: C.A.
Phone: 540-586-5860