Healthcare Provider Details

I. General information

NPI: 1235395948
Provider Name (Legal Business Name): ATLANTIC COAST CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5267 GREENWICH RD SUITE 201
VIRGINIA BEACH VA
23462-6028
US

IV. Provider business mailing address

5267 GREENWICH RD SUITE 201
VIRGINIA BEACH VA
23462-6028
US

V. Phone/Fax

Practice location:
  • Phone: 757-313-6723
  • Fax: 757-313-4596
Mailing address:
  • Phone: 757-313-6723
  • Fax: 757-313-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555605
License Number StateVA

VIII. Authorized Official

Name: DR. MITHRA JIGME GREEN
Title or Position: OWNER
Credential: D.C.
Phone: 757-313-6723