Provider Demographics
NPI:1548374580
Name:VERONA CHIROPRACTIC PC
Entity type:Organization
Organization Name:VERONA CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:ROBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-248-5711
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0036
Mailing Address - Country:US
Mailing Address - Phone:540-248-5711
Mailing Address - Fax:540-248-3744
Practice Address - Street 1:24 IDLEWOOD BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9303
Practice Address - Country:US
Practice Address - Phone:540-248-5711
Practice Address - Fax:540-248-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1012427OtherAMERICAN SPECIALTY HEALTH
VA172952OtherANTHEM BCBS
VA253401OtherSOUTHERN HEALTH SERVICES
VA3721057OtherOPTUM HEALTH PYSICAL HEALTH
VA3721057OtherOPTUM HEALTH PYSICAL HEALTH
VA253401OtherSOUTHERN HEALTH SERVICES