Provider Demographics
NPI:1457725376
Name:RED MILL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:RED MILL CHIROPRACTIC LLC
Other - Org Name:COMMONWEALTH CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING LEAD/ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-467-5258
Mailing Address - Street 1:2236 GENERAL BOOTH BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4092
Mailing Address - Country:US
Mailing Address - Phone:757-467-5258
Mailing Address - Fax:757-467-4641
Practice Address - Street 1:2236 GENERAL BOOTH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4092
Practice Address - Country:US
Practice Address - Phone:757-467-5258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty