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General NPI Number Information
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NPI Number | 1841481165
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF CHRISTIANSBURG, PC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 128 OAK TREE BLVD.
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-0000
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Country | US
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Telephone | 606-407-1323
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Fax |
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Provider Business Mailing Address
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Address Line | 128 OAK TREE BLVD.
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-0000
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Country | US
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Telephone | 606-407-1323
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Fax |
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Authorized Official
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Title or Position | CHIRPRACTOR
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Name | DR. JOHN T DICKERSON III
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Credential | D.C.
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Telephone | 606-407-1323
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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 | 0104556559
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License Number State | VA
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