Provider Demographics
NPI:1548700420
Name:VIRGINIA BEACH INTEGRATIVE CARE
Entity type:Organization
Organization Name:VIRGINIA BEACH INTEGRATIVE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:FIORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:757-410-5322
Mailing Address - Street 1:1421 KEMPSVILLE RD
Mailing Address - Street 2:C
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1406
Mailing Address - Country:US
Mailing Address - Phone:757-410-5322
Mailing Address - Fax:
Practice Address - Street 1:1421 KEMPSVILLE RD
Practice Address - Street 2:C
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1406
Practice Address - Country:US
Practice Address - Phone:757-410-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty