Healthcare Provider Details

I. General information

NPI: 1699896100
Provider Name (Legal Business Name): BRICE SPRINGER JACKSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 FOUR LEAF LN SUITE 202
CHARLOTTESVILLE VA
22903-6905
US

IV. Provider business mailing address

375 FOUR LEAF LN SUITE 202
CHARLOTTESVILLE VA
22903-6905
US

V. Phone/Fax

Practice location:
  • Phone: 434-823-2199
  • Fax:
Mailing address:
  • Phone: 434-823-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number0104556630
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: