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General NPI Number Information
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NPI Number | 1700983681
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC CENTER OF RICHMOND, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 115 BROAD STREET RD
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City | MANAKIN SABOT
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State | VA
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Zip | 23103-2218
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Country | US
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Telephone | 804-784-0161
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Fax |
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Provider Business Mailing Address
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Address Line | 115 BROAD STREET RD
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City | MANAKIN SABOT
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State | VA
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Zip | 23103-2218
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Country | US
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Telephone | 804-784-0161
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ERIC CARLSEN
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Credential | D.C.
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Telephone | 804-784-0161
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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 | 0104001759
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License Number State | VA
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