Provider Demographics
NPI:1669629085
Name:BACK IN ACTION CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERV
Authorized Official - Suffix:
Authorized Official - Credentials:CCSP
Authorized Official - Phone:804-254-0200
Mailing Address - Street 1:4911 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3601
Mailing Address - Country:US
Mailing Address - Phone:804-254-0200
Mailing Address - Fax:804-254-1953
Practice Address - Street 1:4911 AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3601
Practice Address - Country:US
Practice Address - Phone:804-254-0200
Practice Address - Fax:804-254-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001775111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10546Medicare PIN