MEDICARE: SEASHORE CHIROPRACTIC 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	111N00000X	Chiropractor	0104001359	VA

General Provider Information

NPI Number	:	1760815435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASHORE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2260 SEASHORE SHOPPES
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1364
Country	:	US
Telephone Number	:	757-496-3353
Fax Number	:	757-496-9247

Provider Business Practice Location Address
First Line	:	2260 SEASHORE SHOPPES
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1364
Country	:	US
Telephone Number	:	757-496-3353
Fax Number	:	757-496-9247

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN GILTZ
Credential	:	D.C.
Telephone Number	:	757-496-3353

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	08/16/2013

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Directions to “SEASHORE CHIROPRACTIC LLC ” Practice Location

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