Provider Demographics
NPI:1154329217
Name:EGGLESTON, JOHN STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:EGGLESTON
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 1:100 VICAR PL
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1240
Mailing Address - Country:US
Mailing Address - Phone:434-836-3506
Mailing Address - Fax:434-836-2407
Practice Address - Street 1:100 VICAR PL
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1240
Practice Address - Country:US
Practice Address - Phone:434-836-3506
Practice Address - Fax:434-836-2407
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000066718OtherBLUE CROSS/BLUE SHIELD
VA0000066718OtherBLUE CROSS/BLUE SHIELD
VA350000469Medicare ID - Type Unspecified