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General NPI Number Information
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NPI Number | 1811914591
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Entity Type | Organization
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Legal Business Name | CHESTER FAMILY CHIROPRACTIC CENTER P C
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 4700 BUCKINGHAM CT
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City | CHESTER
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State | VA
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Zip | 23831-4261
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Country | US
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Telephone | 804-796-3221
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Fax | 804-796-1500
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Provider Business Mailing Address
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Address Line | 4700 BUCKINGHAM CT
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City | CHESTER
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State | VA
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Zip | 23831-4261
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Country | US
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Telephone | 804-796-3221
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Fax | 804-796-1500
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADAM ELBAUM
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Credential | D.C.
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Telephone | 804-796-3221
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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 | 0104000950
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104001015
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License Number State | VA
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