Provider Demographics
NPI:1841508447
Name:JOHN STEPHEN EGGLESTON, D.C., P.C.
Entity type:Organization
Organization Name:JOHN STEPHEN EGGLESTON, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-836-3506
Mailing Address - Street 1:100 VICAR PL
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1396
Mailing Address - Country:US
Mailing Address - Phone:434-836-3506
Mailing Address - Fax:434-836-2407
Practice Address - Street 1:100 VICAR PL
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1396
Practice Address - Country:US
Practice Address - Phone:434-836-3506
Practice Address - Fax:434-836-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty