Provider Demographics
NPI:1578952867
Name:BISHOP, DEANN (LAC)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5599 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:TROUTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24175-7125
Mailing Address - Country:US
Mailing Address - Phone:540-992-2882
Mailing Address - Fax:
Practice Address - Street 1:5599 LEE HWY
Practice Address - Street 2:
Practice Address - City:TROUTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24175-7125
Practice Address - Country:US
Practice Address - Phone:540-992-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01211000191171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist