Provider Demographics
NPI:1508902958
Name:BLUE RIDGE CHIROPRACTIC & ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:BLUE RIDGE CHIROPRACTIC & ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDERHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-338-3190
Mailing Address - Street 1:205 E HIRST RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6198
Mailing Address - Country:US
Mailing Address - Phone:540-338-3190
Mailing Address - Fax:
Practice Address - Street 1:205 E HIRST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6198
Practice Address - Country:US
Practice Address - Phone:540-338-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001972111N00000X
VA0104001973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty