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General NPI Number Information
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NPI Number | 1750787222
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Entity Type | Organization
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Legal Business Name | THALIA CHIROPRACTIC AND WELLNESS INC
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Dates
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Enumeration Date | 11/11/2014
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 611 STATION SQUARE CT
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0705
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Country | US
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Telephone | 703-371-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 4136 BONNEY RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1741
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Country | US
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Telephone | 757-340-2817
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. JASON MATTHEW KING
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Credential | D.C.
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Telephone | 703-371-4939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104556719
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License Number State | VA
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