Provider Demographics
NPI:1912444811
Name:CHESTERFIELD CHIROPRACTIC CTR PC
Entity Type:Organization
Organization Name:CHESTERFIELD CHIROPRACTIC CTR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CORBELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-897-0965
Mailing Address - Street 1:11506 ALLECINGIE PKWY
Mailing Address - Street 2:STE 1B
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4327
Mailing Address - Country:US
Mailing Address - Phone:804-897-0965
Mailing Address - Fax:804-897-0968
Practice Address - Street 1:11506 ALLECINGIE PKWY
Practice Address - Street 2:STE 1B
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4327
Practice Address - Country:US
Practice Address - Phone:804-897-0965
Practice Address - Fax:804-897-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
350953836Medicare UPIN