Provider Demographics
NPI:1922025881
Name:DEBARROS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:DEBARROS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEBARROS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-730-2609
Mailing Address - Street 1:7020 COLD HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-5045
Mailing Address - Country:US
Mailing Address - Phone:804-730-2609
Mailing Address - Fax:804-730-6496
Practice Address - Street 1:7020 COLD HARBOR RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-5045
Practice Address - Country:US
Practice Address - Phone:804-730-2609
Practice Address - Fax:804-730-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000738111N00000X
VA0104556836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA103297Medicare PIN
VAT88932Medicare UPIN
VA350000342Medicare PIN