MEDICARE: LIGHTKEEPER CHIROPRACTIC PLLC

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	0104555854	VA

General Provider Information

NPI Number	:	1700226610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTKEEPER CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 4296
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-0296
Country	:	US
Telephone Number	:	757-498-8700
Fax Number	:	757-498-8764

Provider Business Practice Location Address
First Line	:	325 FIRST COLONIAL RD
Second Line	:	SUITE A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4665
Country	:	US
Telephone Number	:	757-498-8700
Fax Number	:	757-498-8764

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. CHRISTINE LEIGH FALLWELL
Credential	:	D.C.
Telephone Number	:	757-498-8700

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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