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General NPI Number Information
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NPI Number | 1396963591
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 5000 RIVERSIDE DR SUITE C
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City | DANVILLE
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State | VA
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Zip | 24541-5641
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Country | US
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Telephone | 434-822-2222
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Fax | 434-822-2101
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Provider Business Mailing Address
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Address Line | 5000 RIVERSIDE DR SUITE C
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City | DANVILLE
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State | VA
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Zip | 24541-5641
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Country | US
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Telephone | 434-822-2222
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Fax | 434-822-2101
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | DR. LINDA ANN BLACKMORE
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Credential | DC
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Telephone | 434-822-2222
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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 | 0104001140
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License Number State | VA
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