MEDICARE: DR. JOSEPH DOE AFOR 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	0104556319	VA

General Provider Information

NPI Number	:	1891893350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH DOE AFOR DC

Provider Business Mailing Address
First Line	:	532 INDEPENDENCE BLVD
Second Line	:	PEMBROKE PARK SHOPPES
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-2221
Country	:	US
Telephone Number	:	757-456-5222
Fax Number	:	757-456-2998

Provider Business Practice Location Address
First Line	:	532 INDEPENDENCE BLVD
Second Line	:	PEMBROKE PARK SHOPPES
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-2221
Country	:	US
Telephone Number	:	757-456-5222
Fax Number	:	757-456-2998

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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