Provider Demographics
NPI:1306913025
Name:WEST END CHIROPRACTIC CARE, INC.
Entity type:Organization
Organization Name:WEST END CHIROPRACTIC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-360-2273
Mailing Address - Street 1:3460 LAUDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7529
Mailing Address - Country:US
Mailing Address - Phone:804-360-2273
Mailing Address - Fax:804-360-7996
Practice Address - Street 1:3460 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7529
Practice Address - Country:US
Practice Address - Phone:804-360-2273
Practice Address - Fax:804-360-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAW93209000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09587Medicare PIN