Provider Demographics
NPI:1295804979
Name:DOCKERY CLINIC, LLC
Entity type:Organization
Organization Name:DOCKERY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-886-0010
Mailing Address - Street 1:1410 CHURCHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-1718
Mailing Address - Country:US
Mailing Address - Phone:540-886-0010
Mailing Address - Fax:540-886-0045
Practice Address - Street 1:1410 CHURCHVILLE AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-1718
Practice Address - Country:US
Practice Address - Phone:540-886-0010
Practice Address - Fax:540-886-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA323226OtherANTHEM
VA350000787Medicare ID - Type Unspecified
VA323226OtherANTHEM