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General NPI Number Information
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NPI Number | 1225237852
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Entity Type | Organization
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Legal Business Name | SALLY MOCK, DC, PC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 206 AMBRIAR PLAZA
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City | AMHERST
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State | VA
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Zip | 24521-0343
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Country | US
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Telephone | 434-946-0796
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Fax | 434-946-0736
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Provider Business Mailing Address
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Address Line | PO BOX 343
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City | AMHERST
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State | VA
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Zip | 24521-0343
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Country | US
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Telephone | 434-946-0796
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Fax | 434-946-0736
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SALLY JO MOCK
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Credential | D.C., P.C.
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Telephone | 434-946-0796
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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 | 0104002001
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License Number State | VA
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