Provider Demographics
NPI:1396709002
Name:VANDERHURST, PERRY JOHN JR (DC)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:JOHN
Last Name:VANDERHURST
Suffix:JR
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 1:205 E HIRST RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6198
Mailing Address - Country:US
Mailing Address - Phone:540-338-3190
Mailing Address - Fax:540-338-3695
Practice Address - Street 1:205 E HIRST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6198
Practice Address - Country:US
Practice Address - Phone:540-338-3190
Practice Address - Fax:540-338-3695
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA434044OtherANTHEM BCBS
VA434044OtherANTHEM BCBS
350001266Medicare ID - Type Unspecified