Healthcare Provider Details

I. General information

NPI: 1760540561
Provider Name (Legal Business Name): BACK TO HEALTH CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 N WITCHDUCK RD SUITE C
VIRGINIA BEACH VA
23462-6544
US

IV. Provider business mailing address

256 N WITHCDUCK RD SUITE C
VA BEACH VA
23462
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-4432
  • Fax: 757-518-8831
Mailing address:
  • Phone: 757-499-4432
  • Fax: 757-518-8831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0104001848
License Number StateVA

VIII. Authorized Official

Name: MRS. VIRGINIA JOY VENTERS
Title or Position: DR VENTERS OWNER
Credential: DC
Phone: 757-499-4432