Provider Demographics
NPI:1497825079
Name:BACK IN ACTION CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRES DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BERV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-254-0200
Mailing Address - Street 1:4908 MONUMENT AVENUE
Mailing Address - Street 2:100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3613
Mailing Address - Country:US
Mailing Address - Phone:804-254-0200
Mailing Address - Fax:804-254-1953
Practice Address - Street 1:4908 MONUMENT AVENUE
Practice Address - Street 2:100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3613
Practice Address - Country:US
Practice Address - Phone:804-254-0200
Practice Address - Fax:804-254-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty