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General NPI Number Information
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NPI Number | 1205061751
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE CHIROPRACTIC AND MASSAGE THERAPY CENTER
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 1550 INSURANCE LN
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-7229
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Country | US
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Telephone | 434-296-8100
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Fax | 434-975-1023
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Provider Business Mailing Address
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Address Line | 1550 INSURANCE LN
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-7229
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Country | US
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Telephone | 434-296-8100
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Fax | 434-975-1023
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBORAH M. SANDERSON
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Credential | D.C.
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Telephone | 434-296-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0104556193
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License Number State | VA
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