Provider Demographics
NPI:1124425442
Name:BAYSIDE CHIROPRACTIC REHAB AND LASER
Entity type:Organization
Organization Name:BAYSIDE CHIROPRACTIC REHAB AND LASER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:HOOKS
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-331-1190
Mailing Address - Street 1:117 MASON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310-3135
Mailing Address - Country:US
Mailing Address - Phone:757-331-1190
Mailing Address - Fax:757-331-1260
Practice Address - Street 1:117 MASON AVE STE F
Practice Address - Street 2:
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310-3135
Practice Address - Country:US
Practice Address - Phone:757-331-1190
Practice Address - Fax:757-331-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty