Provider Demographics
NPI:1912324419
Name:INNERSUN FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:INNERSUN FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-682-5815
Mailing Address - Street 1:4915 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4149
Mailing Address - Country:US
Mailing Address - Phone:540-682-5815
Mailing Address - Fax:
Practice Address - Street 1:4915 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4149
Practice Address - Country:US
Practice Address - Phone:540-682-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020286R58Medicare Oscar/Certification