Healthcare Provider Details

I. General information

NPI: 1497825079
Provider Name (Legal Business Name): BACK IN ACTION CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 MONUMENT AVENUE 100
RICHMOND VA
23230-3613
US

IV. Provider business mailing address

4908 MONUMENT AVENUE 100
RICHMOND VA
23230-3613
US

V. Phone/Fax

Practice location:
  • Phone: 804-254-0200
  • Fax: 804-254-1953
Mailing address:
  • Phone: 804-254-0200
  • Fax: 804-254-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE MAE BERV
Title or Position: V PRES DIRECTOR OF OPERATIONS
Credential:
Phone: 804-254-0200