Provider Demographics
NPI:1235312208
Name:VIRGINIA WELLNESS ASSOCIATES NORFOLK, INC.
Entity Type:Organization
Organization Name:VIRGINIA WELLNESS ASSOCIATES NORFOLK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-285-4201
Mailing Address - Street 1:6804 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3429
Mailing Address - Country:US
Mailing Address - Phone:804-285-4201
Mailing Address - Fax:804-285-4202
Practice Address - Street 1:738 W 22ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1983
Practice Address - Country:US
Practice Address - Phone:757-627-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty