Provider Demographics
NPI:1225237852
Name:SALLY MOCK, DC, PC
Entity Type:Organization
Organization Name:SALLY MOCK, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:434-946-0796
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:24521-0343
Practice Address - Country:US
Practice Address - Phone:434-946-0796
Practice Address - Fax:434-946-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258897OtherANTHEM OF VA
VA258897OtherANTHEM OF VA