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General NPI Number Information
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NPI Number | 1598833519
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Entity Type | Organization
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Legal Business Name | GST MANAGEMENT COMPANY
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1212 CORPORATE CIR SW
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City | ROANOKE
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State | VA
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Zip | 24018-1491
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Country | US
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Telephone | 540-776-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 CORPORATE CIR SW
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City | ROANOKE
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State | VA
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Zip | 24018-1491
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Country | US
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Telephone | 540-776-8200
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. APRIL T FRIDLEY
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Credential |
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Telephone | 540-776-8200
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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 | 0104001794
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License Number State | VA
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