MEDICARE: STEPHENS CITY CHIROPRACTIC PLC

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	261QM2500X	Medical Specialty Clinic/Center	0104001281	VA

General Provider Information

NPI Number	:	1740579960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHENS CITY CHIROPRACTIC PLC

Provider Business Mailing Address
First Line	:	5436 MAIN ST
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-2829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5436 MAIN ST
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-2829
Country	:	US
Telephone Number	:	540-869-3034
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	DUANE HUDSPATH
Credential	:
Telephone Number	:	540-869-3034

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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