Healthcare Provider Details

I. General information

NPI: 1376588756
Provider Name (Legal Business Name): STINE CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 REDWOOD DRIVE
FREDERICKSBURG VA
22408
US

IV. Provider business mailing address

117 REDWOOD DRIVE
FREDERICKSBURG VA
22408
US

V. Phone/Fax

Practice location:
  • Phone: 540-898-4100
  • Fax: 540-898-9004
Mailing address:
  • Phone: 540-898-4100
  • Fax: 540-898-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number0104000612
License Number StateVA

VIII. Authorized Official

Name: DR. LARRY L. STINE
Title or Position: OWNER
Credential: D.C.
Phone: 540-898-4100