MEDICARE: AXIS MEDICAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	111NN0400X	Neurology Chiropractor
3	163W00000X	Registered Nurse
4	175L00000X	Homeopath
5	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician
6	261Q00000X	Clinic/Center
7	261QH0100X	Health Service Clinic/Center
8	261QM2500X	Medical Specialty Clinic/Center
9	261QP2000X	Physical Therapy Clinic/Center
10	261QP2300X	Primary Care Clinic/Center
11	261QP3300X	Pain Clinic/Center
12	261QR0200X	Radiology Clinic/Center
13	261QR1100X	Research Clinic/Center
14	332B00000X	Durable Medical Equipment & Medical Supplies
15	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1871247759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS MEDICAL

Provider Business Mailing Address
First Line	:	4542 BONNEY RD STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3867
Country	:	US
Telephone Number	:	757-965-2476
Fax Number	:

Provider Business Practice Location Address
First Line	:	4542 BONNEY RD STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3867
Country	:	US
Telephone Number	:	757-965-2476
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARION CONSTANTINIDES
Credential	:	DC
Telephone Number	:	757-965-2476

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	08/31/2022

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Directions to “AXIS MEDICAL ” Practice Location

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