Provider Demographics
NPI:1770776544
Name:NORFOLK CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:NORFOLK CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NIBLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, NMD
Authorized Official - Phone:757-622-8777
Mailing Address - Street 1:425 W 20TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2128
Mailing Address - Country:US
Mailing Address - Phone:757-622-8777
Mailing Address - Fax:757-623-2079
Practice Address - Street 1:2200 COLONIAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1915
Practice Address - Country:US
Practice Address - Phone:757-622-8777
Practice Address - Fax:757-623-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0300675Medicaid
VA0300675Medicaid