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General NPI Number Information
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NPI Number | 1700181393
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE FAMILY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 220 VALLEY ST E
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City | ABINGDON
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State | VA
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Zip | 24210-2910
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Country | US
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Telephone | 276-676-3111
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Fax | 276-676-2778
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Provider Business Mailing Address
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Address Line | 220 VALLEY ST E
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City | ABINGDON
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State | VA
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Zip | 24210-2910
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Country | US
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Telephone | 276-676-3111
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Fax | 276-676-2778
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Authorized Official
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Title or Position | OWNER
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Name | DR. DYLAN DANIEL LEVESQUE
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Credential | DC
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Telephone | 276-676-3111
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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 | 0104001589
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License Number State | VA
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