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General NPI Number Information
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NPI Number | 1972831113
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC OF HAMPTON ROADS, PLLC
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 1920 CENTERVILLE TPKE SUITE 95
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6800
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Country | US
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Telephone | 757-351-3778
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Fax | 757-479-8855
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Provider Business Mailing Address
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Address Line | 1920 CENTERVILLE TPKE SUITE 95
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6800
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Country | US
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Telephone | 757-351-3778
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Fax | 757-479-8855
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SHAUN CHARLES JACKSON
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Credential | D.C.
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Telephone | 757-351-3778
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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 | 0104556741
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License Number State | VA
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