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General NPI Number Information
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NPI Number | 1124140918
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Entity Type | Organization
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Legal Business Name | BACK PAIN INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 3333 S CRATER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-9276
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Country | US
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Telephone | 804-733-6870
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Fax | 804-226-9496
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Provider Business Mailing Address
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Address Line | PO BOX 3466
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City | PETERSBURG
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State | VA
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Zip | 23805-3466
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Country | US
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Telephone | 804-226-8923
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Fax | 804-226-9496
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Authorized Official
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Title or Position | MANAGER
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Name | MS. VALERIE IRVIN
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Credential |
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Telephone | 804-226-8923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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