Healthcare Provider Details

I. General information

NPI: 1003134016
Provider Name (Legal Business Name): CAPPS CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 WILLIAMSON RD NW
ROANOKE VA
24012-1700
US

IV. Provider business mailing address

PO BOX 4127
ROANOKE VA
24015-0127
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-9394
  • Fax: 540-344-7154
Mailing address:
  • Phone: 540-344-9779
  • Fax: 540-344-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number104000293
License Number StateVA

VIII. Authorized Official

Name: WILLARD GREGORY CAPPS
Title or Position: OWNER
Credential: CHIROPRACTIC
Phone: 540-362-3700