Organization Active NPI

Tidewater Chiropractic Group P.C.

Doing business as Tidewater Chiropractic

  • Chiropractor
  • Portsmouth, VA
National Provider Identifier
1417097718
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104001982 Issued in VA
Legal business name
TIDEWATER CHIROPRACTIC GROUP P.C.
Doing business as
Tidewater Chiropractic
Practice address
4305 Portsmouth Blvd
Portsmouth, VA 23701-2539
Phone
(757) 465-7299
Fax
(757) 465-7282
NPI assigned
Feb 7, 2007
Last updated
Feb 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cornelius Tucker Carwile III, D.C.
Title
President Clinic Director
Phone
(757) 465-7299

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104001982 VA Primary

Addresses

Primary practice location

4305 Portsmouth Blvd
Portsmouth, VA 23701-2539

Mailing address

4305 Portsmouth Blvd
Portsmouth, VA 23701-2539
Phone (757) 465-7299

Other names 1

  • Tidewater Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

4305 Portsmouth Blvd
Portsmouth, VA 23701
Phone (757) 465-7299

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1417097718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 PORTSMOUTH BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237012539",
            "telephone_number": "757-465-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 PORTSMOUTH BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237012539",
            "telephone_number": "757-465-7299",
            "fax_number": "757-465-7282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER CHIROPRACTIC GROUP P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "CARWILE",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_middle_name": "TUCKER",
        "authorized_official_title_or_position": "PRESIDENT CLINIC DIRECTOR",
        "authorized_official_telephone_number": "757-465-7299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104001982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portsmouth, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.