Provider Demographics
NPI:1255683421
Name:ATLANTIC CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ATLANTIC CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SVIHLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-868-8822
Mailing Address - Street 1:360 WYTHE CREEK RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1975
Mailing Address - Country:US
Mailing Address - Phone:757-868-8822
Mailing Address - Fax:757-868-8844
Practice Address - Street 1:360 WYTHE CREEK RD
Practice Address - Street 2:SUITE E
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1975
Practice Address - Country:US
Practice Address - Phone:757-868-8822
Practice Address - Fax:757-868-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty