Provider Demographics
NPI:1003134016
Name:CAPPS CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:CAPPS CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTIC
Authorized Official - Phone:540-362-3700
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-344-9779
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:5220 WILLIAMSON RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1700
Practice Address - Country:US
Practice Address - Phone:540-981-9394
Practice Address - Fax:540-344-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104000293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000409Medicare PIN
U22141Medicare UPIN