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General NPI Number Information
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NPI Number | 1295407989
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Entity Type | Individual
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Provider Name | NICHOLAS VINCENT BLEDSOE DC
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Gender | Male
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 118 FAIRGROUND RD
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City | WOODSTOCK
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State | VA
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Zip | 22664-1102
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Country | US
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Telephone | 540-459-3900
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Fax | 540-459-3951
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Provider Business Mailing Address
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Address Line | 2575 DAWSON DR UNIT 203
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City | ROCKINGHAM
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State | VA
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Zip | 22801-3096
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Country | US
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Telephone | 239-218-4276
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Fax |
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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 | 0104557767
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License Number State | VA
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