=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952455875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCKY MOUNT CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 546 PELL AVE
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-483-7620
-----------------------------------------------------
Fax | 540-483-7739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 546 PELL AVE
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-483-7620
-----------------------------------------------------
Fax | 540-483-7739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | TINA FAYE CALLAWAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-483-7620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104001574
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104001373
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------