Healthcare Provider Details

I. General information

NPI: 1144797176
Provider Name (Legal Business Name): DALE C LIMBROCK PA-C, DMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24164 BELLEAU AVE
QUANTICO VA
22134-5106
US

IV. Provider business mailing address

36 FRANCIS CT
STAFFORD VA
22554-7681
US

V. Phone/Fax

Practice location:
  • Phone: 703-432-6477
  • Fax:
Mailing address:
  • Phone: 719-433-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: