Healthcare Provider Details

I. General information

NPI: 1740579960
Provider Name (Legal Business Name): STEPHENS CITY CHIROPRACTIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5436 MAIN ST
STEPHENS CITY VA
22655-2829
US

IV. Provider business mailing address

5436 MAIN ST
STEPHENS CITY VA
22655-2829
US

V. Phone/Fax

Practice location:
  • Phone: 540-869-3034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0104001281
License Number StateVA

VIII. Authorized Official

Name: DUANE HUDSPATH
Title or Position: OFFICER
Credential:
Phone: 540-869-3034