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General NPI Number Information
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NPI Number | 1700958287
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Entity Type | Organization
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Legal Business Name | MSP INC.
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 2000 GENERAL BOOTH BLVD SUITE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5876
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Country | US
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Telephone | 757-430-0990
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Fax | 757-271-0013
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Provider Business Mailing Address
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Address Line | 2000 GENERAL BOOTH BLVD SUITE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5876
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Country | US
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Telephone | 757-430-0990
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Fax | 757-271-0013
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL PANKOW
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Credential | DC
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Telephone | 757-430-0990
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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 |
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License Number State | VA
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