Provider Demographics
NPI:1003967233
Name:MASK CHIROPRACTIC AND ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:MASK CHIROPRACTIC AND ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MASK
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIPL AC
Authorized Official - Phone:540-885-8877
Mailing Address - Street 1:639 N COALTER ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3404
Mailing Address - Country:US
Mailing Address - Phone:540-885-8877
Mailing Address - Fax:540-887-8493
Practice Address - Street 1:639 N COALTER ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3404
Practice Address - Country:US
Practice Address - Phone:540-885-8877
Practice Address - Fax:540-887-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555811111N00000X
VA0104002066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09442Medicare ID - Type Unspecified