Healthcare Provider Details

I. General information

NPI: 1669629085
Provider Name (Legal Business Name): BACK IN ACTION CHIROPRACTIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 AUGUSTA AVE
RICHMOND VA
23230-3601
US

IV. Provider business mailing address

4911 AUGUSTA AVE
RICHMOND VA
23230-3601
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 Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104001775
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID A. BERV
Title or Position: PRESIDENT
Credential: C.C.S.P.
Phone: 804-254-0200