Provider Demographics
NPI:1902396054
Name:VIRGINIA SPORT & SPINE INSTITUTE LLC
Entity Type:Organization
Organization Name:VIRGINIA SPORT & SPINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-851-0091
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-5128
Mailing Address - Country:US
Mailing Address - Phone:434-851-0091
Mailing Address - Fax:
Practice Address - Street 1:2203 GRAVES MILL RD STE A
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551
Practice Address - Country:US
Practice Address - Phone:434-851-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556303OtherSTATE LICENSE
VAS5931580OtherSTATE CORPORATION COMMISSION