Provider Demographics
NPI:1588610612
Name:PLANET CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PLANET CHIROPRACTIC, LLC
Other - Org Name:PLANET CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-529-2703
Mailing Address - Street 1:1409 KEMPSVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8134
Mailing Address - Country:US
Mailing Address - Phone:757-410-2793
Mailing Address - Fax:
Practice Address - Street 1:1409 KEMPSVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8134
Practice Address - Country:US
Practice Address - Phone:757-410-2793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty