Healthcare Provider Details

I. General information

NPI: 1356522817
Provider Name (Legal Business Name): MIDLOTHIAN CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9924 MIDLOTHIAN TPKE
RICHMOND VA
23235-4814
US

IV. Provider business mailing address

9924 MIDLOTHIAN TPKE
RICHMOND VA
23235-4814
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-9050
  • Fax: 804-320-9048
Mailing address:
  • Phone: 804-320-9050
  • Fax: 804-320-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104000670
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL DOUGLAS JOHNSON
Title or Position: OWNER
Credential: D.C.
Phone: 804-320-9050