MEDICARE: SHAUN HAIRSTON 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	0104558093	VA

General Provider Information

NPI Number	:	1639050909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN HAIRSTON DC

Provider Business Mailing Address
First Line	:	814 COMMERCE DR STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8823
Country	:	US
Telephone Number	:	630-468-1824
Fax Number	:

Provider Business Practice Location Address
First Line	:	3507 BOULEVARD STE A
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1319
Country	:	US
Telephone Number	:	804-526-7125
Fax Number	:

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

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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Directions to “ SHAUN HAIRSTON DC” Practice Location

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