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General NPI Number Information
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NPI Number | 1962465187
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Entity Type | Organization
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Legal Business Name | BOOTHE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 642 NORTH MAIN ST
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City | MARION
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State | VA
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Zip | 24354
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Country | US
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Telephone | 276-783-7005
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Fax | 276-783-8080
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Provider Business Mailing Address
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Address Line | 642 NORTH MAIN ST
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City | MARION
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State | VA
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Zip | 24354
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Country | US
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Telephone | 276-783-7005
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Fax | 276-783-8080
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. SAMUEL KENNETH BOOTHE
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Credential | DC
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Telephone | 276-783-7005
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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 | 0104555931
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104001760
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104556300
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License Number State | VA
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