Provider Demographics
NPI:1093712382
Name:MOCK, SALLY JO (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:JO
Last Name:MOCK
Suffix:
Gender:F
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-0343
Mailing Address - Country:US
Mailing Address - Phone:434-946-0796
Mailing Address - Fax:434-946-0736
Practice Address - Street 1:206 AMBRIAR PLAZA
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521
Practice Address - Country:US
Practice Address - Phone:434-946-0796
Practice Address - Fax:434-946-0736
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258897OtherANTHEM
VA258897OtherANTHEM