Provider Demographics
NPI:1639221500
Name:RICHMOND CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:RICHMOND CHIROPRACTIC, INC.
Other - Org Name:AMBROSE CHIROPRACTIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FIAMA
Authorized Official - Phone:804-897-6130
Mailing Address - Street 1:535 SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3042
Mailing Address - Country:US
Mailing Address - Phone:804-897-6130
Mailing Address - Fax:804-924-2168
Practice Address - Street 1:535 SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3042
Practice Address - Country:US
Practice Address - Phone:804-897-6130
Practice Address - Fax:804-924-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty