Provider Demographics
NPI:1609132414
Name:HUNDLEY CHIROPRACTIC AND SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:HUNDLEY CHIROPRACTIC AND SPORTS MEDICINE, INC.
Other - Org Name:MCCLELLAND CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:HUNDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-382-3333
Mailing Address - Street 1:155 WALTERS DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1041
Mailing Address - Country:US
Mailing Address - Phone:540-382-3333
Mailing Address - Fax:540-381-1958
Practice Address - Street 1:155 WALTERS DR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1041
Practice Address - Country:US
Practice Address - Phone:540-382-3333
Practice Address - Fax:540-381-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU75780Medicare UPIN