1235395948 NPI number — ATLANTIC COAST CHIROPRACTIC, P.C.

Table of content: (NPI 1235395948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235395948 NPI number — ATLANTIC COAST CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC COAST CHIROPRACTIC, P.C.
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:
Provider Other Organization Name Type Code:
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:
1235395948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5267 GREENWICH RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-6028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-313-6723
Provider Business Mailing Address Fax Number:
757-313-4596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5267 GREENWICH RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-6028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-313-6723
Provider Business Practice Location Address Fax Number:
757-313-4596
Provider Enumeration Date:
08/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
MITHRA
Authorized Official Middle Name:
JIGME
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-313-6723

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104555605 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 292354 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2282482 . This is a "THE MAILHANDLER'S BENEFIT PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com