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General NPI Number Information
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NPI Number | 1386163368
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Entity Type | Organization
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Legal Business Name | VIRGINIA CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4 REEDER CIR APT 35B
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City | FORT MONROE
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State | VA
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Zip | 23651-1027
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Country | US
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Telephone | 757-755-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 4 REEDER CIR APT 35B
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City | FORT MONROE
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State | VA
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Zip | 23651-1027
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Country | US
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Telephone | 757-755-5565
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MATTHEW BUDAVICH
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Credential | D.C.
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Telephone | 757-755-5565
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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 | 0104557370
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License Number State | VA
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