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General NPI Number Information
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NPI Number | 1629307632
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Entity Type | Organization
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Legal Business Name | CREATIVE MEDICAL INSTITUTE, LTD.
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Dates
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Enumeration Date | 12/22/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 5589 GREENWICH RD 175
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6565
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Country | US
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Telephone | 757-490-9311
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Fax | 757-490-9266
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Provider Business Mailing Address
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Address Line | 5589 GREENWICH RD 175
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6565
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Country | US
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Telephone | 757-490-9311
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Fax | 757-490-9266
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Authorized Official
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Title or Position | MANAGER
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Name | CHRISTINE FORSYTH VAN VLEEK
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Credential |
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Telephone | 757-490-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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