49D0875358 CLIA NUMBER - MIDLOTHIAN FAMILY PRACTICE WATERFORD VIRGINIA PHYSICIANS, INC

Laboratory Demographics

CLIA Number: 49D0875358

Facility Name: MIDLOTHIAN FAMILY PRACTICE WATERFORD VIRGINIA PHYSICIANS, INC

Facility Address:
3000 WATERCOVE ROAD
MIDLOTHIAN, VA
ZIP 23112
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Facility Phone Number: 804 836-1136

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1104467711

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	49D0875358
LAB Type	Physician Office
Facility Name	MIDLOTHIAN FAMILY PRACTICE WATERFORD VIRGINIA PHYSICIANS, INC
Street	3000 WATERCOVE ROAD
City	MIDLOTHIAN
State	VA
ZIP	23112
Phone	804 836-1136
CertificateType	2
CertificateEffectiveDate	12/15/2023
CertificateExpirationDate	12/14/2025
FacilityType	Compliance

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This page was last updated on: 4/23/2024