Healthcare Provider Details

I. General information

NPI: 1750406302
Provider Name (Legal Business Name): SMITH MOUNTAIN LAKE CHIROPRACTIC CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15388 MONETA RD
MONETA VA
24121-5876
US

IV. Provider business mailing address

15388 MONETA RD
MONETA VA
24121-5876
US

V. Phone/Fax

Practice location:
  • Phone: 540-297-1085
  • Fax:
Mailing address:
  • Phone: 540-297-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0104000790
License Number StateVA

VIII. Authorized Official

Name: DR. JAMES ANDREW SCHAIBLE
Title or Position: CHIROPRACTOR PRESIDENT
Credential: DC
Phone: 540-297-1085