Provider Demographics
NPI:1598703696
Name:VIRGINIA WELLNESS ASSOCIATES INC.
Entity Type:Organization
Organization Name:VIRGINIA WELLNESS ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECATUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-285-4201
Mailing Address - Street 1:6804 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3429
Mailing Address - Country:US
Mailing Address - Phone:804-285-4201
Mailing Address - Fax:
Practice Address - Street 1:11201B W HUGUENOT RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-3302
Practice Address - Country:US
Practice Address - Phone:804-560-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08730Medicare PIN