Healthcare Provider Details

I. General information

NPI: 1710246889
Provider Name (Legal Business Name): CONNECTIONS CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 FOUR LEAF LN SUITE 202
CHARLOTTESVILLE VA
22903-6905
US

IV. Provider business mailing address

375 FOUR LEAF LN SUITE 202
CHARLOTTESVILLE VA
22903-6905
US

V. Phone/Fax

Practice location:
  • Phone: 434-823-2199
  • Fax: 434-823-7099
Mailing address:
  • Phone: 434-823-2199
  • Fax: 434-823-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008083
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119004835
License Number StateVA

VIII. Authorized Official

Name: DR. MEGAN JACKSON
Title or Position: DIRECTOR
Credential: DC
Phone: 434-823-2199