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General NPI Number Information
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NPI Number | 1184844995
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Entity Type | Organization
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Legal Business Name | NORTHERN NECK CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 351 SOUTH MAIN STREET
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City | KILMARNOCK
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State | VA
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Zip | 22482-1447
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Country | US
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Telephone | 804-435-3333
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Fax | 804-435-1933
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Provider Business Mailing Address
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Address Line | 351 S MAIN ST P.O. BOX 1447
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City | KILMARNOCK
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State | VA
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Zip | 22482-1447
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Country | US
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Telephone | 804-435-3333
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Fax | 804-435-1933
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDIST JEEMS LOVE
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Credential | D.C.
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Telephone | 804-435-3333
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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 | 0104000874
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License Number State | VA
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