Provider Demographics
NPI:1235278565
Name:THE SPINE CENTER OF ROANOKE VALLEY, INC.
Entity Type:Organization
Organization Name:THE SPINE CENTER OF ROANOKE VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-774-2513
Mailing Address - Street 1:4504 STARKEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8540
Mailing Address - Country:US
Mailing Address - Phone:540-774-2513
Mailing Address - Fax:540-774-0669
Practice Address - Street 1:4504 STARKEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8540
Practice Address - Country:US
Practice Address - Phone:540-774-2513
Practice Address - Fax:540-774-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty