Provider Demographics
NPI:1760673636
Name:CHIROPRACTIC CARE CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:434-525-4588
Mailing Address - Street 1:1084 THOMAS JEFFERSON RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1084 THOMAS JEFFERSON RD
Practice Address - Street 2:UNIT 12
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2275
Practice Address - Country:US
Practice Address - Phone:434-525-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA461938OtherANTHEM
VA350001202Medicare PIN
VA461938OtherANTHEM