Provider Demographics
NPI:1831694405
Name:BEDFORD CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:BEDFORD CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SELANDER
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:540-586-5860
Mailing Address - Street 1:1029 TURNPIKE RD STE C
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1811
Mailing Address - Country:US
Mailing Address - Phone:540-586-5860
Mailing Address - Fax:540-586-4930
Practice Address - Street 1:1029 TURNPIKE RD STE C
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1811
Practice Address - Country:US
Practice Address - Phone:540-586-5860
Practice Address - Fax:540-586-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557198261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center