Provider Demographics
NPI:1972993632
Name:GLOUCESTER CHIROPRACTIC & MASSAGE
Entity type:Organization
Organization Name:GLOUCESTER CHIROPRACTIC & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-642-6106
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER PT
Mailing Address - State:VA
Mailing Address - Zip Code:23062-0632
Mailing Address - Country:US
Mailing Address - Phone:804-642-6106
Mailing Address - Fax:
Practice Address - Street 1:2654 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3464
Practice Address - Country:US
Practice Address - Phone:804-642-6106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty