Healthcare Provider Details

I. General information

NPI: 1508935396
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 GLOUCESTER RD
SALUDA VA
23149-2590
US

IV. Provider business mailing address

498 GLOUCESTER RD
SALUDA VA
23149-2590
US

V. Phone/Fax

Practice location:
  • Phone: 804-758-1800
  • Fax: 804-758-1803
Mailing address:
  • Phone: 804-758-1800
  • Fax: 804-758-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555799
License Number StateVA

VIII. Authorized Official

Name: MRS. KIMBERLY ANN LEMON JR.
Title or Position: OFFICE ADMIN
Credential:
Phone: 804-758-1800