Provider Demographics
NPI:1578518460
Name:VANDERHURST, CHRISTINA MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:VANDERHURST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:VANDERHURST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
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:540-338-3695
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:540-338-3695
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001265Medicare ID - Type Unspecified
VAU90618Medicare UPIN