Provider Demographics
NPI:1174672497
Name:CHIROCARE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CHIROCARE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTWAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-485-5666
Mailing Address - Street 1:838 OLD GEORGE WASHINGTON HWY N
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2209
Mailing Address - Country:US
Mailing Address - Phone:757-485-5666
Mailing Address - Fax:
Practice Address - Street 1:838 OLD GEORGE WASHINGTON HWY N
Practice Address - Street 2:SUITE E
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2209
Practice Address - Country:US
Practice Address - Phone:757-485-5666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV00882Medicare UPIN
VAC09612Medicare ID - Type UnspecifiedGROUP