Provider Demographics
NPI:1497958086
Name:OCEAN CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:OCEAN CHIROPRACTIC CENTER, PC
Other - Org Name:OCEAN LIGHTFORCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SPELLINGS
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-425-1421
Mailing Address - Street 1:1023 LASKIN RD STE 111
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6302
Mailing Address - Country:US
Mailing Address - Phone:757-425-1421
Mailing Address - Fax:
Practice Address - Street 1:1023 LASKIN RD STE 111
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6302
Practice Address - Country:US
Practice Address - Phone:757-425-1421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-09
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01253Medicare PIN