Provider Demographics
NPI:1205021888
Name:DOMINION FAMILY CHIROPRACTIC P C
Entity Type:Organization
Organization Name:DOMINION FAMILY CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-576-1040
Mailing Address - Street 1:630 CEDAR RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8375
Mailing Address - Country:US
Mailing Address - Phone:757-547-4000
Mailing Address - Fax:757-547-4000
Practice Address - Street 1:630 CEDAR RD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8375
Practice Address - Country:US
Practice Address - Phone:757-547-4000
Practice Address - Fax:757-547-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09787Medicare PIN