Provider Demographics
NPI:1992003834
Name:RADFORD CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:RADFORD CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-731-3842
Mailing Address - Street 1:PO BOX 3362
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-3362
Mailing Address - Country:US
Mailing Address - Phone:540-731-3842
Mailing Address - Fax:540-731-9452
Practice Address - Street 1:601 3RD ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1409
Practice Address - Country:US
Practice Address - Phone:540-731-3842
Practice Address - Fax:540-731-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty