Provider Demographics
NPI:1104854934
Name:ERVIN, JOSEPH LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEE
Last Name:ERVIN
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 1:117 NORTH HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802
Mailing Address - Country:US
Mailing Address - Phone:540-434-5720
Mailing Address - Fax:540-434-4068
Practice Address - Street 1:117 NORTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802
Practice Address - Country:US
Practice Address - Phone:540-434-5720
Practice Address - Fax:540-434-4068
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
096692OtherANTHEM
T21959Medicare UPIN
VA350001085Medicare ID - Type Unspecified