Healthcare Provider Details

I. General information

NPI: 1770689614
Provider Name (Legal Business Name): HARBOUR POINTE CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6003 HARBOUR PARK DR
MIDLOTHIAN VA
23112-2160
US

IV. Provider business mailing address

2433 HARTLEPOOL LN
MIDLOTHIAN VA
23113-6700
US

V. Phone/Fax

Practice location:
  • Phone: 804-745-7822
  • Fax: 804-745-7804
Mailing address:
  • Phone: 804-745-7822
  • Fax: 804-745-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number104556260
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL P PLACIDE
Title or Position: PRESIDENT DOCTOR
Credential: BS DC
Phone: 804-745-7822