Provider Demographics
NPI:1144409772
Name:CONOVER CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:CONOVER CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-591-8834
Mailing Address - Street 1:9610 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-4541
Mailing Address - Country:US
Mailing Address - Phone:757-591-8834
Mailing Address - Fax:757-591-2542
Practice Address - Street 1:11015 WARWICK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3225
Practice Address - Country:US
Practice Address - Phone:757-591-8834
Practice Address - Fax:757-591-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9531211Medicaid
350037642Medicare PIN
VAU46811Medicare UPIN
VA9531211Medicaid
VA350000877Medicare PIN
VAU61751Medicare UPIN