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General NPI Number Information
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NPI Number | 1104944073
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Entity Type | Organization
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Legal Business Name | VELLA CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 12/08/2008
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Provider Practice Location Address
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Address Line | 4224 HOLLAND RD STE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1900
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Country | US
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Telephone | 757-486-4772
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Fax | 757-486-6511
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Provider Business Mailing Address
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Address Line | 4224 HOLLAND RD STE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1900
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Country | US
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Telephone | 757-486-4772
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Fax | 757-486-6511
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACI M VELLA
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Credential | DC
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Telephone | 757-486-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0204000795
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License Number State | VA
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