Provider Demographics
NPI:1932498359
Name:CENTRAL VIRGINIA DISC CENTER
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA DISC CENTER
Other - Org Name:RICHMOND DISC 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 1:201 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:2011-04-06
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556096OtherVIRGINIA STATE LICENSE
1932498359OtherTYPE TWO NPI