Provider Demographics
NPI:1073225934
Name:SHEPHERD, BRIAN AUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:AUSTIN
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3514
Mailing Address - Country:US
Mailing Address - Phone:540-562-3100
Mailing Address - Fax:
Practice Address - Street 1:2900 PETERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3514
Practice Address - Country:US
Practice Address - Phone:540-562-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor