Healthcare Provider Details

I. General information

NPI: 1588611933
Provider Name (Legal Business Name): JAPHET LEGRANT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MARKETPLACE DR SUITE 102
ROCKY MOUNT VA
24151-6516
US

IV. Provider business mailing address

441-G PINEY FOREST ROAD
DANVILLE VA
24540-4154
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-3678
  • Fax: 540-783-3820
Mailing address:
  • Phone: 434-793-0700
  • Fax: 434-793-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: