=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356396196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABBOTT FAMILY CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 COMMERCE DR STE 280
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-838-8820
-----------------------------------------------------
Fax | 757-838-8823
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 COMMERCE DR STE 280
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-838-8820
-----------------------------------------------------
Fax | 757-838-8823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR OWNER
-----------------------------------------------------
Name | DR. SIOBHAN ALISON ABBOTT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 757-838-8820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556420
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------