Healthcare Provider Details

I. General information

NPI: 1497910269
Provider Name (Legal Business Name): PRECISION SPINAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 EXECUTIVE BLVD SUITE 170
CHESAPEAKE VA
23320-3676
US

IV. Provider business mailing address

1305 EXECUTIVE BLVD SUITE 170
CHESAPEAKE VA
23320-3676
US

V. Phone/Fax

Practice location:
  • Phone: 757-382-5555
  • Fax: 757-382-5556
Mailing address:
  • Phone: 757-382-5555
  • Fax: 757-382-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556052
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556541
License Number StateVA

VIII. Authorized Official

Name: DR. ALLEN DAYTON HARRISON
Title or Position: ASSOCIATE DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 757-382-5555