Provider Demographics
NPI:1275119216
Name:HAMPTON ROADS ACUPUNCTURE AND WELLNESS LLC
Entity Type:Organization
Organization Name:HAMPTON ROADS ACUPUNCTURE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:757-793-0633
Mailing Address - Street 1:129 W VA BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2030
Mailing Address - Country:US
Mailing Address - Phone:757-793-0633
Mailing Address - Fax:757-299-2997
Practice Address - Street 1:129 W VA BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2030
Practice Address - Country:US
Practice Address - Phone:757-793-0633
Practice Address - Fax:757-299-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0121000760OtherVA BOARD OF MEDICINE LIC. #