Provider Demographics
NPI:1750851804
Name:VIRGINIA APPLIED KINESIOLOGY LLC
Entity Type:Organization
Organization Name:VIRGINIA APPLIED KINESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ECCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-412-0100
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 E BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3117
Practice Address - Country:US
Practice Address - Phone:757-412-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty