Provider Demographics
NPI:1750406302
Name:SMITH MOUNTAIN LAKE CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:SMITH MOUNTAIN LAKE CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SCHAIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-297-1085
Mailing Address - Street 1:15388 MONETA RD
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-5876
Mailing Address - Country:US
Mailing Address - Phone:540-297-1085
Mailing Address - Fax:
Practice Address - Street 1:15388 MONETA RD
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-5876
Practice Address - Country:US
Practice Address - Phone:540-297-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000790261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA326840Other1
VA0004631055Other2
VA350001012Medicare ID - Type Unspecified
VA0004631055Other2