Healthcare Provider Details

I. General information

NPI: 1245490309
Provider Name (Legal Business Name): VIRGINIA BRAIN AND SPINE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 AMHERST ST
WINCHESTER VA
22601-2869
US

IV. Provider business mailing address

1818 AMHERST ST
WINCHESTER VA
22601-2869
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-0072
  • Fax: 540-450-0074
Mailing address:
  • Phone: 540-450-0072
  • Fax: 540-450-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES B CHADDUCK
Title or Position: PARTNER
Credential: MD
Phone: 540-450-0072