MEDICARE: DR. STACI MARIE VELLA DC

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	111N00000X	Chiropractor	0104000795	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35822	OTHER		MAMSI
2	1024175	OTHER		AMERICAN SPECIALTY HEALTH
3	330556	OTHER	VA	ANTHEM
4	609393	OTHER		ACN

General Provider Information

NPI Number	:	1417045832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACI MARIE VELLA DC

Provider Business Mailing Address
First Line	:	4224 HOLLAND ROAD
Second Line	:	SUITE 110
City	:	VIRGNIA BEACH
State	:	VA
Zip	:	23452-1900
Country	:	US
Telephone Number	:	757-486-4772
Fax Number	:	757-486-6511

Provider Business Practice Location Address
First Line	:	4224 HOLLAND ROAD
Second Line	:	SUITE 110
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1900
Country	:	US
Telephone Number	:	757-486-4772
Fax Number	:	757-486-6511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. STACI MARIE VELLA DC” Practice Location

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