Provider Demographics
NPI:1831483734
Name:BEA, LLC
Entity Type:Organization
Organization Name:BEA, LLC
Other - Org Name:TOTAL HEALTH CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-282-9133
Mailing Address - Street 1:5705 SALEM RUN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7119
Mailing Address - Country:US
Mailing Address - Phone:540-786-4882
Mailing Address - Fax:540-786-4893
Practice Address - Street 1:5705 SALEM RUN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7119
Practice Address - Country:US
Practice Address - Phone:540-786-4882
Practice Address - Fax:540-786-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104555602OtherVIRGINIA MEDICAL LICENSE NUMBER