Provider Demographics
NPI:1306965819
Name:LAURIA, CHRISTOPHER C (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:LAURIA
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 1:5372 FALLOWATER LN
Mailing Address - Street 2:STE B
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0909
Mailing Address - Country:US
Mailing Address - Phone:540-725-9501
Mailing Address - Fax:540-725-9503
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:540-725-9501
Practice Address - Fax:540-725-9503
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000773Medicare ID - Type Unspecified