Healthcare Provider Details

I. General information

NPI: 1831754548
Provider Name (Legal Business Name): KEYSVILLE CHIROPRACTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 KING ST
KEYSVILLE VA
23947
US

IV. Provider business mailing address

PO BOX 24
KEYSVILLE VA
23947-0024
US

V. Phone/Fax

Practice location:
  • Phone: 434-736-9895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: STUART WRIGHT
Title or Position: DR.
Credential: DC
Phone: 434-736-9895