Provider Demographics
NPI:1598854820
Name:CLARKSVILLE CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CLARKSVILLE CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-374-2143
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-0933
Mailing Address - Country:US
Mailing Address - Phone:434-374-2143
Mailing Address - Fax:434-374-8017
Practice Address - Street 1:914 VIRGINIA AVENUE
Practice Address - Street 2:C
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927-0933
Practice Address - Country:US
Practice Address - Phone:434-374-2143
Practice Address - Fax:434-374-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061497OtherANTHEM BCBS