Provider Demographics
NPI:1477626877
Name:LEVESQUE, DYLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:LEVESQUE
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 1:220 EAST VALLEY STREET
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210
Mailing Address - Country:US
Mailing Address - Phone:276-676-3111
Mailing Address - Fax:276-676-2778
Practice Address - Street 1:220 EAST VALLEY STREET
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-676-3111
Practice Address - Fax:276-676-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA241297OtherBCBS PROVIDER NUMBER
VA350000670Medicare ID - Type Unspecified
VAU61392Medicare UPIN