Provider Demographics
NPI:1689885808
Name:RICHMOND CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:RICHMOND CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VASALES
Authorized Official - Middle Name:
Authorized Official - Last Name:ASIMACOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:807-527-0092
Mailing Address - Street 1:201 CONCOURSE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5640
Mailing Address - Country:US
Mailing Address - Phone:804-527-0092
Mailing Address - Fax:804-527-0211
Practice Address - Street 1:201 CONCOURSE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5640
Practice Address - Country:US
Practice Address - Phone:804-527-0092
Practice Address - Fax:804-527-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEDERAL TAX ID
C10574Medicare PIN