Healthcare Provider Details

I. General information

NPI: 1558348995
Provider Name (Legal Business Name): CELESTE MARIE KRAWCHUK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MAIN ST SUITE 102
BERRYVILLE VA
22611-1384
US

IV. Provider business mailing address

101 E MAIN ST SUITE 102
BERRYVILLE VA
22611-1384
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-3355
  • Fax: 540-955-0498
Mailing address:
  • Phone: 540-955-3355
  • Fax: 540-955-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556190
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: