Organization
DIVINE SPINE CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAHEEM Z TOLBERT DC (OWNER)
(804) 668-5918
Entity
Organization
Contact information
Practice address
4205 CROSSINGS BLVD, PRINCE GEORGE, VA 23875
(804) 668-5918
Mailing address
4205 CROSSINGS BLVD, PRINCE GEORGE, VA 23875
(804) 668-5918
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104-557187
VA
Other
Enumeration date
07/28/2014
Last updated
09/30/2014
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