MEDICARE: DR. JOHN STEPHEN EGGLESTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104000855	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000066718	OTHER	VA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1154329217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN STEPHEN EGGLESTON D.C.

Provider Business Mailing Address
First Line	:	100 VICAR PL
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1240
Country	:	US
Telephone Number	:	434-836-3506
Fax Number	:	434-836-2407

Provider Business Practice Location Address
First Line	:	100 VICAR PL
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1240
Country	:	US
Telephone Number	:	434-836-3506
Fax Number	:	434-836-2407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/07/2010

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