Healthcare Provider Details

I. General information

NPI: 1285601955
Provider Name (Legal Business Name): JULIA ANN STICKELL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 02/07/2023
Certification Date: 09/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CORNWALL TER
HAMPTON VA
23666-2811
US

IV. Provider business mailing address

33 CORNWALL TER
HAMPTON VA
23666-2811
US

V. Phone/Fax

Practice location:
  • Phone: 757-633-0192
  • Fax:
Mailing address:
  • Phone: 757-633-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104556116
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556116
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: