Healthcare Provider Details

I. General information

NPI: 1770525800
Provider Name (Legal Business Name): ERIC R STICKLE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20370 TIMBERLAKE RD
LYNCHBURG VA
24502-7213
US

IV. Provider business mailing address

20370 TIMBERLAKE RD
LYNCHBURG VA
24502-7213
US

V. Phone/Fax

Practice location:
  • Phone: 434-239-2243
  • Fax: 434-239-5374
Mailing address:
  • Phone: 434-239-2243
  • Fax: 434-239-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104555600
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: