Provider Demographics
NPI:1669040242
Name:VIE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VIE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-232-7586
Mailing Address - Street 1:6504 47TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1093
Mailing Address - Country:US
Mailing Address - Phone:757-232-7586
Mailing Address - Fax:
Practice Address - Street 1:6504 47TH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1093
Practice Address - Country:US
Practice Address - Phone:757-232-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCH030212OtherLICENSE
MDS04044OtherLICENSE
VA0104557622OtherLICENSE