# CHILDRESS CHIROPRACTIC, SPINAL REHAB & WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134159924
- **Authorized official:** DR. STEPHEN LEWIS CHILDRESS D.C. (OWNER)
- **Authorized official phone:** (276) 889-1314

## Contact information

- **Practice address:** 619 W MAIN ST STE B, LEBANON, VA 24266-3809
- **Practice address phone:** (276) 889-1314
- **Practice address fax:** (276) 889-4125
- **Mailing address:** PO BOX 1300, 619 W MAIN ST STE B, LEBANON, VA 24266-1300
- **Mailing address phone:** (276) 889-1314
- **Mailing address fax:** (276) 889-4125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 0104-001354 | VA | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 04/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000300608 | — | VA |
| 01 | — | 236332 | ANTHEM | VA |
| 01 | — | 5010623 | AETNA | VA |