Healthcare Provider Details

I. General information

NPI: 1548700420
Provider Name (Legal Business Name): VIRGINIA BEACH INTEGRATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 KEMPSVILLE RD C
CHESAPEAKE VA
23320-1406
US

IV. Provider business mailing address

1421 KEMPSVILLE RD C
CHESAPEAKE VA
23320-1406
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-5322
  • Fax:
Mailing address:
  • Phone: 757-410-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANDREA DEANNE FIORILLO
Title or Position: OWNER
Credential: LMT
Phone: 757-410-5322