Healthcare Provider Details

I. General information

NPI: 1194903526
Provider Name (Legal Business Name): DR. SUSAN L EARSING P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 VILLAGE HWY
RUSTBURG VA
24588-2801
US

IV. Provider business mailing address

667 BABCOCK RD
RUSTBURG VA
24588-2801
US

V. Phone/Fax

Practice location:
  • Phone: 434-332-3103
  • Fax:
Mailing address:
  • Phone: 434-332-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555903
License Number StateVA

VIII. Authorized Official

Name: DR. SUSAN LYNN EARSING
Title or Position: PRESIDENT
Credential: DC
Phone: 434-332-3103