MEDICARE: DR. MICHAEL SCOTT NIBLO 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	0104001408	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902809395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT NIBLO DC

Provider Business Mailing Address
First Line	:	425 W 20TH ST
Second Line	:	STE. 6
City	:	NORFOLK
State	:	VA
Zip	:	23517-2128
Country	:	US
Telephone Number	:	757-622-8777
Fax Number	:	757-623-2079

Provider Business Practice Location Address
First Line	:	425 W 20TH ST
Second Line	:	STE.6
City	:	NORFOLK
State	:	VA
Zip	:	23517-2128
Country	:	US
Telephone Number	:	757-622-8777
Fax Number	:	757-623-2079

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/16/2012

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