Healthcare Provider Details

I. General information

NPI: 1932016482
Provider Name (Legal Business Name): GAVIN FARRELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 VIRGINIA BEACH BLVD STE 150
VIRGINIA BEACH VA
23462-7784
US

IV. Provider business mailing address

9620 6TH BAY ST
NORFOLK VA
23518-1108
US

V. Phone/Fax

Practice location:
  • Phone: 757-760-3196
  • Fax:
Mailing address:
  • Phone: 716-345-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16107
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104558164
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: