Healthcare Provider Details

I. General information

NPI: 1932498359
Provider Name (Legal Business Name): CENTRAL VIRGINIA DISC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 06/09/2011
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 Number0104556096
License Number StateVA

VIII. Authorized Official

Name: STEVEN F SHIELDS
Title or Position: BILLING MANAGER
Credential:
Phone: 804-282-9133