Provider Demographics
NPI:1942477328
Name:SOUTH MAIN CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:SOUTH MAIN CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BELLUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-449-2277
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-4898
Mailing Address - Country:US
Mailing Address - Phone:540-449-2277
Mailing Address - Fax:
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:SUITE 401
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-4898
Practice Address - Country:US
Practice Address - Phone:540-449-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1173Medicare UPIN