Healthcare Provider Details

I. General information

NPI: 1275175705
Provider Name (Legal Business Name): COREMEDX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 PINEY FOREST RD STE E
DANVILLE VA
24540-4154
US

IV. Provider business mailing address

441 PINEY FOREST RD STE E
DANVILLE VA
24540-4154
US

V. Phone/Fax

Practice location:
  • Phone: 434-793-0700
  • Fax: 434-797-4444
Mailing address:
  • Phone: 434-793-0700
  • Fax: 434-797-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ISAAC HILL
Title or Position: AUTHORIZED OFFICIAL
Credential: DC
Phone: 434-797-4455