MEDICARE: MSP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		VA

General Provider Information

NPI Number	:	1700958287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSP INC.

Provider Business Mailing Address
First Line	:	2000 GENERAL BOOTH BLVD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5876
Country	:	US
Telephone Number	:	757-430-0990
Fax Number	:	757-271-0013

Provider Business Practice Location Address
First Line	:	2000 GENERAL BOOTH BLVD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5876
Country	:	US
Telephone Number	:	757-430-0990
Fax Number	:	757-271-0013

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL PANKOW
Credential	:	DC
Telephone Number	:	757-430-0990

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	03/19/2012

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Directions to “MSP INC. ” Practice Location

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