Provider Demographics
NPI:1962620542
Name:CHURCH POINT CHIROPRACTIC, PC
Entity type:Organization
Organization Name:CHURCH POINT CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:REINHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-460-2522
Mailing Address - Street 1:4640 SHORE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2859
Mailing Address - Country:US
Mailing Address - Phone:757-460-2522
Mailing Address - Fax:757-460-3810
Practice Address - Street 1:4640 SHORE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2859
Practice Address - Country:US
Practice Address - Phone:757-460-2522
Practice Address - Fax:757-460-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-21
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA320389OtherBCBS PROVIDER ID NUMBER
VA320389OtherBCBS PROVIDER ID NUMBER