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General NPI Number Information
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NPI Number | 1861729188
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Entity Type | Organization
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Legal Business Name | AGAPE CHIROPRACTIC WELLNESS CENTER
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 6070 INDIAN RIVER RD STE. 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-3895
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Country | US
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Telephone | 757-905-0701
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Fax | 877-753-9308
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Provider Business Mailing Address
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Address Line | 6070 INDIAN RIVER ROAD SUITE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-905-0701
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Fax | 877-753-9308
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. SHANE PATRICK MORRISON
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Credential | D.C.
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Telephone | 757-905-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 0104556726
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License Number State | VA
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