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General NPI Number Information
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NPI Number | 1659530665
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Entity Type | Individual
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Provider Name | BRIAN DAVID MYNATT D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 2105 ELECTRIC RD STE 102
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City | ROANOKE
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State | VA
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Zip | 24018-2317
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Country | US
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Telephone | 540-491-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 ELECTRIC RD STE 102
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City | ROANOKE
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State | VA
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Zip | 24018-2317
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Country | US
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Telephone | 540-491-3220
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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 | 0104557070
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License Number State | VA
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