Healthcare Provider Details

I. General information

NPI: 1962741066
Provider Name (Legal Business Name): MEANINGFUL WELLNESS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 POWHATAN ST STE 7
ALEXANDRIA VA
22314-1389
US

IV. Provider business mailing address

1423 POWHATAN ST STE 7
ALEXANDRIA VA
22314-1389
US

V. Phone/Fax

Practice location:
  • Phone: 703-739-7650
  • Fax: 703-836-2667
Mailing address:
  • Phone: 703-739-7650
  • Fax: 703-836-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556891
License Number StateVA

VIII. Authorized Official

Name: DR. SHAWNTE HUDGINS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 301-237-1213