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General NPI Number Information
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NPI Number | 1255517108
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Entity Type | Organization
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Legal Business Name | BAY AREA CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 5301 PROVIDENCE RD SUITE 50
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4128
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Country | US
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Telephone | 757-495-2228
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Fax | 757-495-2216
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Provider Business Mailing Address
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Address Line | 5301 PROVIDENCE RD SUITE 50
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4128
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Country | US
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Telephone | 757-495-2228
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Fax | 757-495-2216
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. WAYNE ROBERT EIBAN
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Credential | DC
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Telephone | 757-495-2228
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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 | 0104000382
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License Number State | VA
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