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General NPI Number Information
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NPI Number | 1972993632
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Entity Type | Organization
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Legal Business Name | GLOUCESTER CHIROPRACTIC & MASSAGE
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 2654 GEORGE WASHINGTON MEMORIAL HWY SUITE 2
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City | HAYES
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State | VA
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Zip | 23072-3464
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Country | US
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Telephone | 804-642-6106
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 632
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City | GLOUCESTER PT
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State | VA
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Zip | 23062-0632
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Country | US
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Telephone | 804-642-6106
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. EARL GENE RATLIFF
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Credential |
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Telephone | 804-642-6106
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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 | 0104556884
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License Number State | VA
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