Provider Demographics
NPI:1639159163
Name:TSCHETSCHOT, PAUL ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERIC
Last Name:TSCHETSCHOT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9283
Mailing Address - Country:US
Mailing Address - Phone:804-862-2255
Mailing Address - Fax:804-862-1004
Practice Address - Street 1:34 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9283
Practice Address - Country:US
Practice Address - Phone:804-862-2255
Practice Address - Fax:804-862-1004
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU65308Medicare UPIN