Provider Demographics
NPI:1508042854
Name:PREMIER CHIROPRACTIC ASSOCIATES PC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC ASSOCIATES PC
Other - Org Name:PREMIER HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-962-6191
Mailing Address - Street 1:633 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE A/B
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-962-6191
Mailing Address - Fax:757-692-7120
Practice Address - Street 1:633 INDEPENDENCE BLVD STE A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2200
Practice Address - Country:US
Practice Address - Phone:757-962-6191
Practice Address - Fax:757-692-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty