MEDICARE: ILLUMINATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	0121000588	VA

General Provider Information

NPI Number	:	1023428133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUMINATION, LLC

Provider Business Mailing Address
First Line	:	1492 S INDEPENDENCE BLVD.
Second Line	:	STE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5252
Country	:	US
Telephone Number	:	757-431-0053
Fax Number	:	757-431-0053

Provider Business Practice Location Address
First Line	:	1492 S INDEPENDENCE BLVD.
Second Line	:	STE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5252
Country	:	US
Telephone Number	:	757-431-0053
Fax Number	:	757-431-0053

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAYNE F DABU
Credential	:	DAOM,L.AC., DIPL.AC.
Telephone Number	:	757-431-0053

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	03/14/2025

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