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General NPI Number Information
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NPI Number | 1235278565
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Entity Type | Organization
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Legal Business Name | THE SPINE CENTER OF ROANOKE VALLEY, INC.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4504 STARKEY RD SUITE 100
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City | ROANOKE
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State | VA
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Zip | 24018-8540
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Country | US
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Telephone | 540-774-2513
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Fax | 540-774-0669
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Provider Business Mailing Address
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Address Line | 4504 STARKEY RD SUITE 100
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City | ROANOKE
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State | VA
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Zip | 24018-8540
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Country | US
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Telephone | 540-774-2513
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Fax | 540-774-0669
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRAVIS STICKLE
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Credential | D.C.
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Telephone | 540-774-2513
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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 | 0104555954
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License Number State | VA
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