Provider Demographics
NPI:1235395948
Name:ATLANTIC COAST CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ATLANTIC COAST CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITHRA
Authorized Official - Middle Name:JIGME
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-313-6723
Mailing Address - Street 1:5267 GREENWICH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6028
Mailing Address - Country:US
Mailing Address - Phone:757-313-6723
Mailing Address - Fax:757-313-4596
Practice Address - Street 1:5267 GREENWICH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6028
Practice Address - Country:US
Practice Address - Phone:757-313-6723
Practice Address - Fax:757-313-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA292354OtherANTHEM BLUE CROSS BLUE SHIELD
VA2282482OtherTHE MAILHANDLER'S BENEFIT PLAN
VA2282482OtherTHE MAILHANDLER'S BENEFIT PLAN
VA292354OtherANTHEM BLUE CROSS BLUE SHIELD