Provider Demographics
NPI:1902109226
Name:BACK IN ACTION CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKORUPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-873-7786
Mailing Address - Street 1:11832 CANON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2580
Mailing Address - Country:US
Mailing Address - Phone:757-873-7786
Mailing Address - Fax:757-223-4187
Practice Address - Street 1:11832 CANON BLVD STE E
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2580
Practice Address - Country:US
Practice Address - Phone:757-873-7786
Practice Address - Fax:757-223-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01040001842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU67328Medicare UPIN