Healthcare Provider Details

I. General information

NPI: 1396709002
Provider Name (Legal Business Name): PERRY JOHN VANDERHURST JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E HIRST RD SUITE 102
PURCELLVILLE VA
20132-6198
US

IV. Provider business mailing address

205 E HIRST RD SUITE 102
PURCELLVILLE VA
20132-6198
US

V. Phone/Fax

Practice location:
  • Phone: 540-338-3190
  • Fax: 540-338-3695
Mailing address:
  • Phone: 540-338-3190
  • Fax: 540-338-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001972
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: