Provider Demographics
NPI:1629119045
Name:ACCIDENT & INJURY CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:ACCIDENT & INJURY CHIROPRACTIC CENTER, INC.
Other - Org Name:APPOMATTOX CHIROPRACTIC & REHAB, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CARLEEN
Authorized Official - Last Name:FUNICELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-385-6333
Mailing Address - Street 1:320 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-1319
Mailing Address - Country:US
Mailing Address - Phone:434-326-5761
Mailing Address - Fax:
Practice Address - Street 1:306 ENTERPRISE DR STE B
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2644
Practice Address - Country:US
Practice Address - Phone:434-385-6333
Practice Address - Fax:434-385-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty