Provider Demographics
NPI:1720086309
Name:TALMADGE, JOHN PAUL (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:TALMADGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 FORT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-1505
Mailing Address - Country:US
Mailing Address - Phone:434-239-4878
Mailing Address - Fax:
Practice Address - Street 1:4847 FORT AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-1505
Practice Address - Country:US
Practice Address - Phone:434-239-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA111166OtherANTHEM BC/BS
VAU20792Medicare UPIN
VA111166OtherANTHEM BC/BS