Healthcare Provider Details

I. General information

NPI: 1740616960
Provider Name (Legal Business Name): BELLA DEA VICTORIA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 05/21/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CHARLOTTE AVE APT 527
NASHVILLE TN
37203-2465
US

IV. Provider business mailing address

2400 CHARLOTTE AVE
NASHVILLE TN
37203-1667
US

V. Phone/Fax

Practice location:
  • Phone: 615-788-1235
  • Fax:
Mailing address:
  • Phone: 615-788-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001125
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104001125
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number0104001125
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3539
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: