Healthcare Provider Details

I. General information

NPI: 1205030152
Provider Name (Legal Business Name): VIRGINIA ST CHIROPRACTIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 E PLAZA EAST BLVD
EVANSVILLE IN
47715-2811
US

IV. Provider business mailing address

4847 E PLAZA EAST BLVD
EVANSVILLE IN
47715-2811
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-4444
  • Fax: 812-477-4561
Mailing address:
  • Phone: 812-477-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: AMBER JAMES
Title or Position: DIRECTOR
Credential: D.C.
Phone: 812-477-4444