Provider Demographics
NPI:1619188356
Name:JIMMIE L. MASK, D.C., P.C.
Entity Type:Organization
Organization Name:JIMMIE L. MASK, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-632-8385
Mailing Address - Street 1:825 MEMORIAL BLVD N
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2418
Mailing Address - Country:US
Mailing Address - Phone:276-632-8385
Mailing Address - Fax:
Practice Address - Street 1:825 MEMORIAL BLVD N
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2418
Practice Address - Country:US
Practice Address - Phone:276-632-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA075006OtherANTHEM
VA8596OtherPARTNERS
VA255239OtherMAMSI
VAU27986Medicare UPIN