Provider Demographics
NPI:1023213212
Name:THE SHENANDOAH CLINIC OF CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:THE SHENANDOAH CLINIC OF CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-442-8555
Mailing Address - Street 1:2040 DEYERLE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801
Mailing Address - Country:US
Mailing Address - Phone:540-442-8555
Mailing Address - Fax:540-442-9555
Practice Address - Street 1:2040 DEYERLE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801
Practice Address - Country:US
Practice Address - Phone:540-442-8555
Practice Address - Fax:540-442-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO9528Medicare ID - Type UnspecifiedMEDICARE