Provider Demographics
NPI:1811914591
Name:CHESTER FAMILY CHIROPRACTIC CENTER P C
Entity type:Organization
Organization Name:CHESTER FAMILY CHIROPRACTIC CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-796-3221
Mailing Address - Street 1:4700 BUCKINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4261
Mailing Address - Country:US
Mailing Address - Phone:804-796-3221
Mailing Address - Fax:804-796-1500
Practice Address - Street 1:4700 BUCKINGHAM CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4261
Practice Address - Country:US
Practice Address - Phone:804-796-3221
Practice Address - Fax:804-796-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000950111N00000X
VA0104001015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA082600OtherANTHEM BCBS
VA8945063Medicaid
VA8945063Medicaid
VA350000509Medicare PIN