Provider Demographics
NPI:1740477967
Name:VIRGINIA INSTITUTE OF CHIROPRACTIC, PLC
Entity type:Organization
Organization Name:VIRGINIA INSTITUTE OF CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-872-9440
Mailing Address - Street 1:1424 GREENBRIER PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-872-9440
Mailing Address - Fax:
Practice Address - Street 1:1424 GREENBRIER PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-872-9440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty