| NPI | 1972831113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN CHARLES JACKSON Owner/Physician 757-351-3778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556741) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2010-02-25 |