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General NPI Number Information
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NPI Number | 1013352699
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Entity Type | Organization
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Legal Business Name | TESTER CHIROPRACTIC LLC.
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 411 EAST MAIN STREET
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City | WISE
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State | VA
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Zip | 24293
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Country | US
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Telephone | 606-216-0842
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3895
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City | WISE
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State | VA
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Zip | 24293-3895
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. BRANDON PAUL TESTER
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Credential | D.C.
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Telephone | 606-216-0842
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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 | 0104557073
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License Number State | VA
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