Provider Demographics
NPI:1235166844
Name:COLEMAN, SAMANTHA (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 INDEPENDENCE BLVD
Mailing Address - Street 2:STE 311
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-0000
Mailing Address - Country:US
Mailing Address - Phone:757-271-0001
Mailing Address - Fax:866-290-7581
Practice Address - Street 1:287 INDEPENDENCE BLVD
Practice Address - Street 2:STE 311
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2962
Practice Address - Country:US
Practice Address - Phone:757-271-0001
Practice Address - Fax:866-290-7581
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09441Medicare ID - Type Unspecified
VA96533Medicare UPIN