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General NPI Number Information
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NPI Number | 1437296027
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Entity Type | Organization
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Legal Business Name | SPINE CARE OF TIDEWATER, P.C.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 2204 EXECUTIVE DR SUITE A
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City | HAMPTON
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State | VA
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Zip | 23666-6602
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Country | US
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Telephone | 757-827-3210
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Fax | 757-827-9089
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Provider Business Mailing Address
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Address Line | 2204 EXECUTIVE DR SUITE A
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City | HAMPTON
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State | VA
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Zip | 23666-6602
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Country | US
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Telephone | 757-827-3210
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Fax | 757-827-9089
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN J. WESTBY
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Credential | D.C.
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Telephone | 757-827-3210
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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 | 0104000693
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License Number State | VA
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