Provider Demographics
NPI:1417235409
Name:BLUE RIDGE CLINIC OF CHIROPRACTIC
Entity Type:Organization
Organization Name:BLUE RIDGE CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-337-1238
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:STUARTS DRAFT
Mailing Address - State:VA
Mailing Address - Zip Code:24477-0641
Mailing Address - Country:US
Mailing Address - Phone:540-337-1238
Mailing Address - Fax:
Practice Address - Street 1:2780 STUARTS DRAFT HWY
Practice Address - Street 2:SUITE #106
Practice Address - City:STUARTS DRAFT
Practice Address - State:VA
Practice Address - Zip Code:24477-2779
Practice Address - Country:US
Practice Address - Phone:540-337-1238
Practice Address - Fax:540-338-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty