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General NPI Number Information
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NPI Number | 1770776544
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Entity Type | Organization
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Legal Business Name | NORFOLK CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 2200 COLONIAL AVE STE 2
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City | NORFOLK
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State | VA
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Zip | 23517-1915
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Country | US
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Telephone | 757-622-8777
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Fax | 757-623-2079
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Provider Business Mailing Address
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Address Line | 425 W 20TH ST STE 6
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City | NORFOLK
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State | VA
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Zip | 23517-2128
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Country | US
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Telephone | 757-622-8777
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Fax | 757-623-2079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL SCOTT NIBLO
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Credential | DC, NMD
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Telephone | 757-622-8777
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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 | 0104001408
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License Number State | VA
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