Provider Demographics
NPI:1215111604
Name:VANAMBERG, MATTHEW BRADLEY (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRADLEY
Last Name:VANAMBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 KENSTOCK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3354
Mailing Address - Country:US
Mailing Address - Phone:757-498-5433
Mailing Address - Fax:
Practice Address - Street 1:2304 KENSTOCK DR STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3354
Practice Address - Country:US
Practice Address - Phone:757-498-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor