Provider Demographics
NPI:1023177086
Name:PROGRESSIVE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:PROGRESSIVE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANZETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-490-8555
Mailing Address - Street 1:4740 BAXTER RD
Mailing Address - Street 2:STE 109
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4484
Mailing Address - Country:US
Mailing Address - Phone:757-490-8555
Mailing Address - Fax:757-490-3838
Practice Address - Street 1:4740 BAXTER RD
Practice Address - Street 2:STE 109
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4484
Practice Address - Country:US
Practice Address - Phone:757-490-8555
Practice Address - Fax:757-490-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA112486OtherBCBS ANTHEM
VA00W057P01Medicare ID - Type Unspecified
VA112486OtherBCBS ANTHEM