Provider Demographics
NPI:1104467711
Name:MIDLOTHIAN FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:MIDLOTHIAN FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-608-3045
Mailing Address - Street 1:2737 BAYFRONT WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4551
Mailing Address - Country:US
Mailing Address - Phone:804-399-9288
Mailing Address - Fax:
Practice Address - Street 1:1500 HUGUENOT RD STE 101
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2478
Practice Address - Country:US
Practice Address - Phone:804-608-3045
Practice Address - Fax:804-767-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty