Provider Demographics
NPI:1861809907
Name:TOLBERT, BRAHEEM (DC)
Entity type:Individual
Prefix:DR
First Name:BRAHEEM
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRAHEEM
Other - Middle Name:Z
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1601 RIVER ROCK RD APT 102
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-6186
Mailing Address - Country:US
Mailing Address - Phone:804-668-5918
Mailing Address - Fax:
Practice Address - Street 1:4205 CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1456
Practice Address - Country:US
Practice Address - Phone:804-668-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor