Healthcare Provider Details

I. General information

NPI: 1780916122
Provider Name (Legal Business Name): MICHELLE REBECCA SEVERSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 TANYARD RD SUITE 102
ROCKY MOUNT VA
24151-1543
US

IV. Provider business mailing address

920 TANYARD RD SUITE G
ROCKY MOUNT VA
24151-1543
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-3678
  • Fax: 540-483-3820
Mailing address:
  • Phone: 540-483-4344
  • Fax: 844-726-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556868
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010498
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: