MEDICARE: AGAPE CHIROPRACTIC WELLNESS CENTER

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	261QR0400X	Rehabilitation Clinic/Center	0104556726	VA

General Provider Information

NPI Number	:	1861729188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE CHIROPRACTIC WELLNESS CENTER

Provider Business Mailing Address
First Line	:	6070 INDIAN RIVER ROAD
Second Line	:	SUITE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464
Country	:	US
Telephone Number	:	757-905-0701
Fax Number	:	877-753-9308

Provider Business Practice Location Address
First Line	:	6070 INDIAN RIVER RD
Second Line	:	STE. 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3895
Country	:	US
Telephone Number	:	757-905-0701
Fax Number	:	877-753-9308

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. SHANE PATRICK MORRISON
Credential	:	D.C.
Telephone Number	:	757-905-0701

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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