1457725376 NPI number — RED MILL CHIROPRACTIC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457725376 NPI number — RED MILL CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED MILL CHIROPRACTIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMONWEALTH CHIROPRACTIC AND PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457725376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2236 GENERAL BOOTH BLVD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23456-4092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-467-5258
Provider Business Mailing Address Fax Number:
757-467-4641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2236 GENERAL BOOTH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456-4092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-467-5258
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING LEAD/ADMIN ASSISTANT
Authorized Official Telephone Number:
757-467-5258

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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