1548374580 NPI number — VERONA CHIROPRACTIC PC

Table of content: (NPI 1548374580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548374580 NPI number — VERONA CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERONA CHIROPRACTIC PC
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:
6
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:
1548374580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22939-0036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-248-5711
Provider Business Mailing Address Fax Number:
540-248-3744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 IDLEWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
STAUNTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24401-9303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-248-5711
Provider Business Practice Location Address Fax Number:
540-248-3744
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBSON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
ELLIS
Authorized Official Title or Position:
PRESIDENT OF CORP
Authorized Official Telephone Number:
540-248-5711

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104001627 , 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: 1012427 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 172952 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 253401 . This is a "SOUTHERN HEALTH SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3721057 . This is a "OPTUM HEALTH PYSICAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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