MEDICARE: TRUE SOURCE CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1609646785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE SOURCE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	4633 PEMBROKE LAKE CIR STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6404
Country	:	US
Telephone Number	:	757-937-3558
Fax Number	:

Provider Business Practice Location Address
First Line	:	4633 PEMBROKE LAKE CIR STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6404
Country	:	US
Telephone Number	:	757-937-3558
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	JOSHUA MICHAEL COLLINGSWORTH
Credential	:
Telephone Number	:	757-692-4399

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “TRUE SOURCE CHIROPRACTIC ” Practice Location

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