Healthcare Provider Details

I. General information

NPI: 1619188356
Provider Name (Legal Business Name): JIMMIE L. MASK, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 MEMORIAL BLVD N
MARTINSVILLE VA
24112-2418
US

IV. Provider business mailing address

825 MEMORIAL BLVD N
MARTINSVILLE VA
24112-2418
US

V. Phone/Fax

Practice location:
  • Phone: 276-632-8385
  • Fax:
Mailing address:
  • Phone: 276-632-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000158
License Number StateVA

VIII. Authorized Official

Name: DR. JIMMIE L. MASK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 276-632-8385