Provider Demographics
NPI:1396963591
Name:ADVANCED CHIROPRACTIC PC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLACKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-822-2222
Mailing Address - Street 1:5000 RIVERSIDE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5641
Mailing Address - Country:US
Mailing Address - Phone:434-822-2222
Mailing Address - Fax:434-822-2101
Practice Address - Street 1:5000 RIVERSIDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5641
Practice Address - Country:US
Practice Address - Phone:434-822-2222
Practice Address - Fax:434-822-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA134162OtherGATEWAY
VA216628OtherANTHEM
VA288977OtherMAMSI
VA350053242OtherMEDICARE RAILROAD
VAU47712Medicare UPIN
VA350053242OtherMEDICARE RAILROAD