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General NPI Number Information
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NPI Number | 1013315597
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Entity Type | Organization
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Legal Business Name | ASHLAND-HANOVER PROFESSIONAL CENTER, LLC
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 257 N WASHINGTON HWY
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City | ASHLAND
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State | VA
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Zip | 23005-1623
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Country | US
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Telephone | 804-752-7624
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Fax | 804-752-7625
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Provider Business Mailing Address
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Address Line | 257 N WASHINGTON HWY
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City | ASHLAND
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State | VA
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Zip | 23005-1623
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Country | US
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Telephone | 804-752-7624
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Fax | 804-752-7625
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DONNA M. GRISSOM
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Credential | L.P.N.
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Telephone | 804-752-7624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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