Healthcare Provider Details

I. General information

NPI: 1437504354
Provider Name (Legal Business Name): GARST CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 BRANDON AVE SW
ROANOKE VA
24018-1525
US

IV. Provider business mailing address

3609 BRANDON AVE SW
ROANOKE VA
24018-1525
US

V. Phone/Fax

Practice location:
  • Phone: 540-297-3440
  • Fax: 540-297-9313
Mailing address:
  • Phone: 540-297-3440
  • Fax: 540-297-9313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number0104000405
License Number StateVA

VIII. Authorized Official

Name: DR. GARY B GARST
Title or Position: OWNER
Credential: D.C.
Phone: 540-297-3440