MEDICARE: VIRGINIA SPINAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104556586	GA

General Provider Information

NPI Number	:	1972781920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA SPINAL GROUP

Provider Business Mailing Address
First Line	:	1444 KEMPSVILLE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7302
Country	:	US
Telephone Number	:	757-474-7890
Fax Number	:	757-747-7931

Provider Business Practice Location Address
First Line	:	1444 KEMPSVILLE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7302
Country	:	US
Telephone Number	:	757-474-7890
Fax Number	:	757-747-7931

Authorized Official
Title or Position	:	OWNER
Name	:	JAY B BERKOWITZ
Credential	:	DC
Telephone Number	:	757-474-7490

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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Directions to “VIRGINIA SPINAL GROUP ” Practice Location

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