Individual
STEPHEN LEWIS CHILDRESS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
619 W MAIN ST STE B, LEBANON, VA 24266-3809
(276) 889-1314
(276) 889-4125
Mailing address
PO BOX 1300, 307 W MAIN STREET, LEBANON, VA 24266
(276) 889-2200
(276) 889-2202
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104001354
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0300608
—
VA
01
—
236332
ANTHEM
VA
01
—
5010623
AETNA
VA
Enumeration date
05/11/2006
Last updated
05/05/2017
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