Provider Demographics
NPI:1396816633
Name:WILLIAMSBURG CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:WILLIAMSBURG CHIROPRACTIC CLINIC
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DR OF CHIROPRACTIC PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILDING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-220-0060
Mailing Address - Street 1:5252 OLDE TOWNE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188
Mailing Address - Country:US
Mailing Address - Phone:757-220-0060
Mailing Address - Fax:757-229-3481
Practice Address - Street 1:5252 OLDE TOWNE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-220-0060
Practice Address - Fax:757-229-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA066925OtherBCBS
=========OtherTAX ID NUMBER