Provider Demographics
NPI:1700958287
Name:MSP INC.
Entity Type:Organization
Organization Name:MSP INC.
Other - Org Name:BEACH CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-430-0990
Mailing Address - Street 1:2000 GENERAL BOOTH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5876
Mailing Address - Country:US
Mailing Address - Phone:757-430-0990
Mailing Address - Fax:757-271-0013
Practice Address - Street 1:2000 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5876
Practice Address - Country:US
Practice Address - Phone:757-430-0990
Practice Address - Fax:757-271-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08680Medicare PIN