MEDICARE: DR. LONNIE A SLONE 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	0104000372	VA

General Provider Information

NPI Number	:	1609860675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LONNIE A SLONE DC

Provider Business Mailing Address
First Line	:	111 W VA BEACH BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2005
Country	:	US
Telephone Number	:	757-623-7776
Fax Number	:	757-623-1522

Provider Business Practice Location Address
First Line	:	111 W VA BEACH BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2005
Country	:	US
Telephone Number	:	757-623-7776
Fax Number	:	757-623-1522

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	10/17/2007

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