Provider Demographics
NPI:1952455875
Name:ROCKY MOUNT CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ROCKY MOUNT CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:CALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-483-7620
Mailing Address - Street 1:546 PELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151
Mailing Address - Country:US
Mailing Address - Phone:540-483-7620
Mailing Address - Fax:540-483-7739
Practice Address - Street 1:546 PELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151
Practice Address - Country:US
Practice Address - Phone:540-483-7620
Practice Address - Fax:540-483-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001373111N00000X
VA0104001574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA337526OtherBCBS
7470475OtherAETNA
5900064OtherAETNA
VA260654OtherBCBS