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General NPI Number Information
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NPI Number | 1164467577
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Entity Type | Individual
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Provider Name | WILLIAM BLAINE LIKINS III DC
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 1084 THOMAS JEFFERSON RD UNIT 12
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City | FOREST
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State | VA
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Zip | 24551-2275
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Country | US
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Telephone | 434-525-4588
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Fax | 434-525-4514
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Provider Business Mailing Address
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Address Line | 109 TRINITY CT
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City | LYNCHBURG
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State | VA
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Zip | 24502-5264
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Country | US
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Telephone | 434-525-4588
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Fax | 434-525-4514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0104555971
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License Number State | VA
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