Provider Demographics
NPI:1962656934
Name:ATLANTIC CHIROPRACTIC AND REHABILITATION PC
Entity Type:Organization
Organization Name:ATLANTIC CHIROPRACTIC AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SANTJER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-547-2045
Mailing Address - Street 1:115 KEMPSVILLE RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3857
Mailing Address - Country:US
Mailing Address - Phone:757-547-2045
Mailing Address - Fax:757-547-2027
Practice Address - Street 1:115 KEMPSVILLE RD
Practice Address - Street 2:STE. 1
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3857
Practice Address - Country:US
Practice Address - Phone:757-547-2045
Practice Address - Fax:757-547-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 111NN1001X
VA885111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO9683Medicare PIN
VADR0935Medicare PIN