Provider Demographics
NPI:1699157578
Name:DESTRO CHIROPRACTIC
Entity type:Organization
Organization Name:DESTRO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:J
Authorized Official - Last Name:DESTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-748-4800
Mailing Address - Street 1:11936A CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1701
Mailing Address - Country:US
Mailing Address - Phone:804-748-4800
Mailing Address - Fax:
Practice Address - Street 1:11936A CENTRE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1701
Practice Address - Country:US
Practice Address - Phone:804-748-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty