Healthcare Provider Details

I. General information

NPI: 1689885808
Provider Name (Legal Business Name): RICHMOND CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CONCOURSE BLVD SUITE 102
GLEN ALLEN VA
23059-5640
US

IV. Provider business mailing address

201 CONCOURSE BLVD SUITE 102
GLEN ALLEN VA
23059-5640
US

V. Phone/Fax

Practice location:
  • Phone: 804-527-0092
  • Fax: 804-527-0211
Mailing address:
  • Phone: 804-527-0092
  • Fax: 804-527-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555602
License Number StateVA

VIII. Authorized Official

Name: MR. VASALES ASIMACOPOULOS
Title or Position: MEMBER OWNER
Credential: DC
Phone: 807-527-0092