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General NPI Number Information
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NPI Number | 1477025393
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Entity Type | Organization
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Legal Business Name | EAST COAST ELITE CHIROPRACTIC PLC
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 204 N MAIN ST
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City | BLACKSTONE
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State | VA
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Zip | 23824-1426
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Country | US
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Telephone | 434-298-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N MAIN ST
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City | BLACKSTONE
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State | VA
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Zip | 23824-1426
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Country | US
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Telephone | 434-298-0707
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | ROBY T MYERS
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Credential | DC
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Telephone | 434-298-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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