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General NPI Number Information
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NPI Number | 1295803492
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Entity Type | Organization
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Legal Business Name | ML BAWCOM & ASSOCIATES
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 762 INDEPENDENCE BLVD SUITE 786
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6200
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Country | US
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Telephone | 757-490-7911
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Fax | 757-490-7918
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Provider Business Mailing Address
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Address Line | 762 INDEPENDENCE BLVD SUITE 786
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6200
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Country | US
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Telephone | 757-490-7911
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Fax | 757-490-7918
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. MARK LEWIS BAWCOM
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Credential | D.C.
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Telephone | 757-490-7911
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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 | 0104001771
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License Number State | VA
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