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General NPI Number Information
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NPI Number | 1588843023
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Entity Type | Organization
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Legal Business Name | BASIC ESSENTIALS SPINAL CARE CENTER
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 2744 GLENDALE RD
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City | GALAX
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State | VA
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Zip | 24333-5350
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Country | US
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Telephone | 276-236-3833
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Fax | 276-236-9376
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Provider Business Mailing Address
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Address Line | 2744 GLENDALE RD
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City | GALAX
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State | VA
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Zip | 24333-5350
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Country | US
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Telephone | 276-236-3833
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Fax | 276-236-9376
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. WADE EDWARD SPROVIERO
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Credential | D.C.
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Telephone | 273-236-3833
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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 | 0104000891
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License Number State | VA
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